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Urological Institute Europe (EAU) in the first prostate cancer treatment guidelines published in 2001. In the past few years, whenever affect prostate cancer (CaP) clinical treatment of the important changes, EAU Guide will be updated. In August 2005, EAU again updated the prostate cancer treatment guidelines. From www.uroweb.org new website will be a complete version of the Guide.
Working group on new data from the literature review, in accordance with evidence-based medicine (EBM), insert the evidence and recommended grade level, so as to help readers better understand the quality of the information recommended.
Following the guidelines in prostate cancer risk factors, screening, diagnosis, staging and treatment principles introduced separately.
A prostate cancer risk factors
The updated guidelines state that clinical genetic factors in determining the risk of prostate cancer, is very important, external factors such risk can also have a significant impact. The key question is whether there is recommendable evidence that lifestyle changes (reduced intake of animal fat and more fresh fruit, vegetables and grains) can reduce that risk. Some existing evidence of this, in prostate cancer patients with male relatives on diet advice when such information could be provided to them (Evidence level 3 ~ 4).
2, prostate cancer screening
The census is right or mass screening of asymptomatic risk groups to be checked. Usually only in the screening test or study, the screening will be conducted. But random screening or early detection can be found sporadic cases. Usually by the screening (patients) or their doctors to decide whether to conduct such screening.
There are two ongoing large randomized study to evaluate the effect of screening the CaP, in the United States the PLCO (prostate, lung, colorectal and ovarian) study conducted in Europe and the ERSPC Europe (Random prostate cancer screening) Research. In 2008 the two will be the main destination - CaP death rate differences - for the first time analysis (the level of evidence: a).
Therefore, the current lack of evidence to support or ignore specific group of people in all of the male CaP early mass screening. Will prostate-specific antigen (PSA) and the DRE (DRE) joint inspection with a good knowledge of early diagnosis is not controversial, and has been widely used in clinical (Evidence level: 3).
3, prostate cancer diagnosis and staging
Through an in-depth diagnosis and staging of work, taking into account the age and patients with complications, patients can determine the treatment program. To avoid the use of the treatment decision-making role with the operation. The following is a list of CaP diagnosis and staging of seven guidance:
1. Results abnormal DRE or elevated serum PSA testing can be used as indications of CaP. The normal PSA level of precision critical value has not yet been determined, but usually with PSA levels of 2.5 to 3 ng / ml in normal young men as a standard. (Grade C recommendation)
2. CaP rely on the histopathological diagnosis (or cytology) Diagnosis (Grade B recommendation). According to the management of patients with biopsy needs to be done and further phases.
3. The majority of patients with suspected prostate cancer, recommended the use of transrectal ultrasound-guided biopsy diagnosis system. Recommend prostate biopsy sampling of the direction of at least six to ten points, the larger the prostate to more sampling points. (Grade B recommendation)
• The transitional zone biopsy detection rate lower, not recommended at the first biopsy sampling at this site. (Grade C recommendation)
The persistence of CaP indications (DRE abnormal PSA increase, or the first tissue biopsy pathologic findings suggested that malignant disease) patients to re - biopsy. (Grade B recommendation)
• Overall not recommended for more biopsy (three or more); Whether patients can only be decided. (Grade C recommendation)
4. For patients with rectal prostate local anesthesia around the injection drugs, will accept patients with prostate biopsy effective anesthesia. (Grade A recommendation)
5. According DRE results and may have MRI examination results, a local judge prostate cancer staging (T stage). Positive results of the prostate biopsy number and location of sampling percentage point involvement, tumor grade and serum PSA level can provide more diagnostic information. (Grade C recommendation)
6. Only when curative treatment plan, lymph node status would be more important (N period). T2 or less stages (PSA <20 ng / ml, and the Gleason score <6), the possibility of lymph node metastasis of less than 10%, eliminating lymph node evaluation.
Only lymph node dissection to determine the accurate lymph node staging. (Grade B recommendation)
7. Right bone metastasis (M) is the best method of evaluation of bone scanning. Serum PSA levels below 20 ng / ml, or moderately well-differentiated tumor differentiation of asymptomatic patients may conduct this evaluation. (Grade B recommendation)
4, prostate cancer treatment
Usually it is not possible to describe a treatment program than the other treatment programs better, in this area because of the lack of randomized controlled study. But based on the available literature, the program can still make some recommendations. The initial treatment of prostate cancer patients choose the overall program are shown in Table 1, Table outlined a detailed classification according to the diagnosis of stage treatment program. (Yuan Yin)
Table 1 initial treatment of prostate cancer guidance Prostate cancer family care points Prostate cancer symptoms for the next performance of urinary tract obstruction, frequency, novel, difficulty urinating, urinary and fine, s... Prostate cancer is the main symptoms Because prostate cancer occurred in the posterior lobe, slow growth, was buried after, the early muscle, once the symptoms are often relativ... The main symptoms of prostate cancer is what Because prostate cancer occurred in the posterior lobe, slow growth, was buried after, the early muscle, once the symptoms are often relati... Symptoms, signs and diagnosis Prostate cancer generally slower development, can be asymptomatic. There will be advanced disease bladder outlet obstruction or ureteral ob... Prostate cancer killer of men can trace From after originally thought to the end of the story, the elimination of the disease, with disease farewell. However, it often tangled up,... Vitamin E is anti - prostate cancer Prostate cancer is the second biggest killer of men, the medical profession is still not completely cured of the disease method. Prostate sp... Lack of vitamin D increase the risk of prostate cancer Prostate cancer in several categories
Staging
Treatment
Notes
Variables
Watchful waiting
Right differentiated and well-differentiated tumor, life expectancy <10 patients with the use of standard therapy. The life expectancy of> 10 patients, subject to the rectal ultrasound (TUR) and biopsy re-staging. (Grade B recommendation)
Radical prostatectomy
Life expectancy is longer, in particular the low level of tumor differentiation young patients a choice. (Grade B recommendation)
Radiotherapy
Life expectancy is longer, in particular the low level of tumor differentiation young patients a choice.
In TURP after a higher risk of complications, especially within the Organization especially radiotherapy. (Grade B recommendation)
Hormone therapy
It is not appropriate choice. (Grade A recommendation)
Combined treatment
It is not appropriate choice. (Grade C recommendation)
T1b - MIDDLE
Watchful waiting
The degree of tumor differentiation and moderately good, and life expectancy <10 of asymptomatic patients.
No treatment-related complications in patients. (Grade B recommendation)
Radical prostatectomy
The life expectancy is> 10, and treatment of complications associated with the standard treatment. (Grade A recommendation)
Radiotherapy
Life expectancy of> 10, and treatment of complications associated with. There contraindications surgery patients. Life expectancy in five to 10 years, low-grade tumor and the general condition of the poor patients. (Recommended in the treatment; See bet) (Grade B recommendation)
Hormone therapy
To ease the symptoms of patients and inappropriate use of the therapy to cure patients. (Grade C recommendation).
Simple anti - androgen treatment than watchful waiting even worse the prognosis, not recommended. (Grade A recommendation)
Combined treatment
Preoperative neoadjuvant hormone therapy (NHT) radical prostatectomy: no proven benefit. (Grade A recommendation)
Sketch radiotherapy: the best use of local treatment. Unconfirmed can increase the survival rate. (Grade B recommendation)
Hormone therapy (2 to 3 years) radiotherapy: The effect of poorly differentiated tumors than radiation therapy alone. (Grade A recommendation)
T3 - T4
Watchful waiting
Yes T3, and in well-differentiated tumor differentiation, life expectancy <10 asymptomatic patients with the choice. (Grade C recommendation)
Radical prostatectomy
Yes Gl 5 ~ 7, PSA level is low, life expectancy> 10 patients with the T3a choice. (Grade C recommendation)
Radiotherapy
Life expectancy> 5 ~ 10 patients with T3. The corresponding increase in dose> 70 Gy seems to be useful. If not for the treatment, and recommended the use of combination hormone therapy in the treatment. (Grade A recommendation)
Hormone therapy
T3 to T4, high PSA levels (> 25 ng / ml) symptomatic patients, the general state of poor patients. Better than watchful waiting. (Grade A recommendation)
Combined treatment
Radiotherapy hormone therapy may be better than radiation therapy alone. (Grade A recommendation)
Sketch radical prostatectomy: No benefit can be confirmed. (Grade B recommendation)
N , M0
Watchful waiting
Asymptomatic patients. Patients requirements. Survival rates may have a negative impact. (Grade C recommendation)
Radical prostatectomy
Non-standard options. (Grade C recommendation)
Radiotherapy
Non-standard options. (Grade C recommendation)
Hormone therapy
Standard treatment. (Grade A recommendation)
Combined treatment
Non-standard options. Patients requirements. (Grade B recommendation)
M
Watchful waiting
Non-standard options. Can lead to the immediate hormone therapy than lower survival / more complications. (Grade B recommendation)
Radical prostatectomy
It is not appropriate choice. (Grade C recommendation)
Radiotherapy
It is not appropriate choice. (Grade C recommendation)
Hormone therapy
Standard therapy. There should not be refused treatment in patients with (Grade A recommendation)
Combined treatment
It is not appropriate choice. (Grade C recommendation)
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