Prostat Kanserinde Fokal Tedavi Alternatifleri

1980'lerin sonundan itibaren, prostata özgü antijenin (prostate specific antigen, PSA) klinikte kullanılmaya baslanmasıyla prostat kanseri hastalarının kaderi dramatik olarak değisti. Günümüzde daha fazla sayıda erkek lokalize, küçük, daha az agresif ve ölümcül olmayan prostat kanseri tanısı almaktadır. Klinik olarak lokalize prostat kanserinin tedavisinde, günümüzde radikal prostatektominin yanı sıra, prostatın kriyo-cerrahi ile ablasyonu, brakiterapi ve yüksek yoğunluk odaklı ultrasonografi de alternatif tedavi seçenekleri olarak kabul edilmektedir.Bu derlemede, birincil sonuç olarak lokalize prostat kanserinde fokal tedavi alternatiflerinin basarısı ve komplikasyon oranları belirlemeyi amaçladık. Derlemenin ikincil sonucu ise bu islemler için uygun olan aday hastaların tanımlanmasıydı."Prostat kanserinin fokal tedavi alternatifleri", "yüksek yoğunluk odaklı ultrasonografi ve prostat kanserinin kriyocerrahisi" ve "prostat kanserinin radyofrekans ablasyonu" tanımlamalarıyla Medline taraması yaptık. Toplamda 1173 makale değerlendirildi ve bunlardan içerik olarak uygun bulunan 45 tanesi derlemede kullanıldı.Konuyla ilgili kontrollü çalısma yoktu. Amerikan Üroloji Derneği kılavuzları, prostatın kriyocerrahi ablasyonunu tedavi edici bir yöntem olarak kabul etmektedir; ancak cerrahi ve cerrahi dısı alternatiflerle kıyaslandığında, daha az morbidite ve olasılıkla aynı tedavi etkinliğine sahip minimal invasiv bir yöntem olarak gelistirilmesine rağmen yüksek yoğunluk odaklı ultrasonografi ise hala deneysel olarak kabul edilmektedir.Girisim yapılmadan düzenli takip edilme kriterlerini yakalayan ancak aktif tedavi sansını kaçırma hissiyle anksiyete yasayan hastalarda, fokal tedaviler iyi alternatifler olabilir. Ancak, fokal tedavi seçeneği düsük ve orta dereceli riski olan hastalar için saklanmalıdır. Radyolojik ve klinik evre sırasıyla T2b ve T2a'nın altında olmalıdır. Ek olarak, adaylar alternatiflerin deneysel olduğu ve zaman içinde tedavi seçeneğinin değistirilmesine ihtiyaçları olabileceği yönünde bilgilendirilmelidirler. Yakın gelecekte fokal tedavi alternatifleri daha gerçekçi tedavi seçeneklerine dönüsebilirler, ancak kanıta dayalı veri sağlamak için iyi desenlenmis, çok merkezli randomize prospektif çalısmalara ihtiyaç vardır

Focal Treatment Alternatives in Prostate Cancer

The destiny of prostate cancer patients has been dramatically changed since the introduction of prostate speciŞ c antigen (PSA) into clinical use in late 1980s. Currently more men are diagnosed with localized, small, less aggressive and non-lethal prostatic carcinoma. Besides radical prostatectomy, cryosurgical ablation of the prostate, brachytherapy and high-intensity focused ultrasound have been accepted as alternative treatment options in clinically localized prostatic carcinoma.In this review, we aimed to evaluate the success and complication rates of alternative focal treatment options as the primary outcome. The secondary outcome of this review was to deŞ ne the candidate patients eligible for these procedures.We searched the Medline using speciŞ ed expressions including "focal treatment alternatives of prostatic carcinoma", "high-intensity focused ultrasound and cryosurgery of prostatic carcinoma" and "radiofrequency ablation of prostatic carcinoma". A total of 1173 papers related to the focal treatment options were analyzed and only 45 of them related to the subject were included.There wasn't a controlled trial dealing with the topic. American Urologic Association guidelines have accepted cryosurgical ablation of the prostate as a therapeutic option; however the high-intensity focused ultrasound is still considered as an experimental treatment option, although it has been developed as a minimally invasive procedure with reduced morbidity and potentially with the same therapeutic efŞ cacy in comparison with the surgical or non surgical options.For patients meeting the variable criteria for regular follow up visits without intervention but experiencing anxiety with the feeling of losing active treatment options, focal therapies may be ideal alternatives. However, focal therapy options should be spared for patients with low to moderate risks. The radiologic and clinical stages should be below T2b and T2a, respectively. In addition, all candidates should be informed that the alternatives are considered as experimental and they may need an alternative treatment option in time. Focal therapy alternatives may be more realistic treatment options in the near future; however, well designed multicenter prospective randomized trials are required to provide evidence based data

Kaynakça

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