Dijagnostika i liječenje karcinoma prostate

master's thesis

• Title (english): Diagnostics and treatment of prostate cancer
• Author: Natalija Mihovilić
• Mentor: Borislav Spajić (mentor)
• Committee member: Davor Trnski (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Borislav Spajić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Urology); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Karcinom prostate jedna je od čestih zloćudnih bolesti u muškoj populaciji u razvijenim
zemljama. U Hrvatskoj je karcinom prostate drugi po učestalosti s 15% udjela u
karcinomima, kao i drugi uzrok smrti od svih karcinoma muške populacije, nakon karcinoma
bronha i pluća (HZJZ, bilten 2013). Prirodni tijek bolesti je spor i mnogi muškarci umiru s
njim, a ne od njega. Rizični činitelji za karcinom prostate nisu dobro poznati, ali se zna da
postoji obiteljska sklonost.
Dijagnostika karcinoma prostate danas je dostupnija i preciznija. Digitorektalni pregled
(DRP), serumski prostata specifični antigen (PSA) i biopsija prostate pod kontrolom
transrektalnog ultrazvuka (TRUZ) glavni su alati u dijagnostici. DRP je osnovna pretraga jer
ispravno postavlja sumnju na karcinom u 15-40% slučajeva (Candas i sur. 2000). Ukupni
PSA te omjer slobodnog i ukupnog PSA uzrokovali su revoluciju u dijagnostici karcinoma
prostate jer imaju veću pouzdanost od DRP-a. Najpouzdanija preoperativna metoda za
dokazivanje karcinoma prostate i prekanceroza karcinoma prostate je biopsija prostate pod
kontrolom TRUZ-a. Analizom bioptiranog tkiva doznaje se stupanj diferenciranosti
karcinoma, odnosno Gleasonov zbroj i stupanj proširenosti bolesti. Usprkos dostupnosti ovih
metoda, u trenutku postavljanja dijagnoze polovica bolesnika ima uznapredovalu bolest koja
više nije izlječiva (HZJZ, bilten 2013).
Liječenje lokaliziranog karcinoma prostate uključuje 3 metode. Radikalna prostatektomija
(RP) je metoda izbora za pacijente koji imaju očekivani životni vijek veći od 10 godina.
Specifične kirurške komplikacije ove operacije su inkontinencija i impotencija čija se
incidencija danas smanjuje primjenom laparoskopske RP i robot-asistirane RP. U liječenju se
primjenjuju i konformalna (3D) radioterapija i brahiterapija koje polučuju gotovo jednako
dobre rezultate kao i kirurško liječenje. Pacijentima koji imaju očekivani životni vijek manji
od 10 godina sa značajnim komorbiditetima te karcinomima koji imaju niski maligni
potencijal, preporuča se pomno praćenje, odnosno određivanje PSA uz DRP svakih 6 mjeseci
(Thompson i sur. 2007). Liječenje metastatskog karcinoma prostate u domeni je rada
onkologa.

Abstract (english)

Prostatic carcinoma is one of the most frequent malignant diseases in the male population
in developed countries. In Croatia, prostatic carcinoma is the second most common with 15%
in all carcinomas, as well as the second leading cause of all carcinoma deaths in the male
population, after lung and bronchial carcinoma (HZJZ, bilten 2013). The natural course of the
disease is slow and majority of men die with it, not of it. Risk factors for prostate cancer are
not well understood, but it is known that there is a family predisposition.
Diagnosing prostatic cancer is now more accessible and more precise. Digital rectal
examination (DRE), serum prostate specific antigen (PSA) and prostate biopsy under
transrectal ultrasound control (TRUS) are the main tools in its diagnosing. DRE is
fundamental in diagnosing because it can correctly set the suspicion of cancer in 15-40% of
cases (Candas i sur. 2000). The total PSA and the free/total PSA ratio caused a revolution in
diagnosing prostate cancer because they have a higher reliability than DRE. The most reliable
preoperative method for the detection of prostate cancer and prostate cancer precanceroses is
TRUS guided prostate biopsy. The degree of cancer differentiation (Gleason score) and the
degree of disease spread can be detected by the analysis of biopsy tissue. Despite the
availability of these methods, half of the patients develop advanced disease that is not curable
by the time they are diagnosed (HZJZ, bilten 2013).
Treatment of localized prostate cancer includes 3 methods. Radical prostatectomy (RP) is
the method of choice for patients who have a life expectancy of more than 10 years. Specific
surgical complications of this surgery are incontinence and impotence. Today, the incidence
of these complications is reduced by the use of laparoscopic RP and robot-assisted RP.
Conformal (3D) radiotherapy and brachytherapy are also used in the treatment and show
almost as good results as the surgical treatment. Watchfull waiting or PSA with DRE every 6
months is recommended to patients with low-risk carcinomas who have a life expectancy of
less than 10 years or significant comorbidities (Thompson i sur. 2007). Treatment of
metastatic prostate cancer is in the oncologist’s domain of work.

• Keywords: karcinom prostate; PSA; biopsija; Gleasonov indeks; TRUZ; radikalna prostatektomija; radikalna radioterapija; pomno praćenje
• Keywords (english): prostatic carcinoma; PSA; biopsy; Gleason score; TRUS; radical prostatectomy; radical radiotherapy; active surveillance
• Language: croatian
• URN:NBN: urn:nbn:hr:105:202806
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-14 13:01:31