| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.24 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: Na era do PSA, tem-se verificado uma incidência crescente no número de casos de carcinoma da próstata localizado. Face a esta nova realidade, são necessárias novas estratégias terapêuticas com o intuito de dar resposta aos indivíduos, nos quais, embora possa estar indicada a vigilância activa, pretendem uma conduta terapêutica mais interventiva. Actualmente, a abordagem radical de toda a glândula constitui a única alternativa à vigilância activa. Assim, as terapêuticas focais podem afigurar-se como uma estratégia intermédia eficaz no controlo da doença oncológica, minimizando os efeitos secundários inerentes às abordagens terapêuticas convencionais. Objectivo: Pretende-se avaliar o estado da arte relativamente à utilização das terapêuticas focais no tratamento do carcinoma da próstata localizado, nomeadamente conhecer as características da população alvo, as metodologias utilizadas na selecção dos candidatos, os efeitos adversos das técnicas analisadas, as diferentes modalidades de follow-up e os resultados referentes ao controlo da doença, preservação da continência e função sexual. Metodologia: Utilizaram-se as bases de dados PubMed e ScienceDirect para a realização da pesquisa bibliográfica. Foram analisados artigos publicados entre 01/01/2004 e 31/12/2014. Tendo em conta o objectivo primordial do presente trabalho, incluíram-se todos os estudos realizados em humanos nos quais as diferentes modalidades de terapêutica focal tenham sido utilizadas como terapêutica primária.
Resultados e Discussão: No total foram analisados 35 estudos onde as terapêuticas focais foram utilizadas como tratamento primário. Destes, 9 estudos utilizaram o HIFU, 11 a crioterapia, 3 a terapia fotodinâmica, 6 o laser, 2 a braquiterapia focal e 3 a electroporação irreversível. Apenas 1 estudo incorporou várias técnicas de ablação, designadamente o HIFU, a crioterapia, a terapêutica fotodinâmica e a braquiterapia focal. Estes estudos englobaram um universo total de 2595 indivíduos, a maior parte com doença de baixo e intermédio risco, embora esporadicamente alguns estudos tenham incluído indivíduos com doença de alto risco. O follow-up durou entre 0 e 18 anos. Para a definição da sobrevida livre de recidiva bioquímica foram utilizados vários critérios, tendo sido predominantemente utilizados os critérios de Phoenix e os da ASTRO, ainda que adaptados a este tipo de modalidade terapêutica. Entre 0% a 33% dos indivíduos teve biopsia positiva na área sujeita a tratamento. Genericamente, 60% a 100% dos indivíduos preservaram a continência urinária. Independentemente da forma pela qual foi avaliada, a função eréctil após o tratamento variou entre 33 e 100%. Conclusão: Os resultados obtidos são bastante animadores, principalmente no que toca às técnicas mais estabelecidas (HIFU e crioterapia), com uma população alvo maior e com um follow-up mais prolongado. A despeito desta observação, serão necessários mais estudos na área, principalmente estudos prospectivos e multicêntricos, com critérios uniformes entre si. Dado o interesse crescente nas terapêuticas minimamente invasivas, prevê-se que as terapêuticas focais sejam a futura realidade no tratamento do carcinoma da próstata, principalmente se localizado e de baixo grau.
Introduction: In the PSA era, the number of cases of localised prostate cancer has been increasing. This new reality requires for new therapeutic strategies, in order to give an answer to patients in whom active surveillance may be indicate but desire more interventive strategy. Actually, the radical approach of whole gland is the unique alternative to active surveillance. Thus, focal therapies can be an effective strategy in cancer control, minimizing side effects inherent to conventional therapeutic strategies. Goal: To assess the state of art related to the use of focal therapies on the treatment of localised prostate cancer, namely to know the characteristics of the target population, the methodologies used in the selection of the candidates, the side effects of the analysed techniques, the different follow-up modalities, and the outcomes related to disease control, preservation of urinary continence and erectile function. Methods: PubMed and ScienceDirect databases were used to the literature research. The articles analysed were published between 01/01/2004 and 31/12/2014. All studies were conducted in humans in whom the different modalities of focal therapy have been used as primary therapy. Results and Discussion: Thirty five studies where the focal therapies were used as primary treatment were analysed. Nine of them used HIFU, 11 cryotherapy, 3 photodynamic therapy, 6 laser therapy, 2 focal brachytherapy and 3 irreversible electroporation. Only one study included several ablation techniques, namely HIFU, cryotherapy, photodynamic therapy and focal brachytherapy. These studies encompassed a total universe of 2595 individuals, most of them with low to intermediate-risk disease, although some studies have included patients with high-risk disease. Follow-up lasted between 0 months and 18 years. To define biochemical disease-free survival were used several criteria, but the most used were the Phoenix and the ASTRO, although adapted to this approach. Between 0% to 33% of the patients had positive biopsy on treated area. Overall, 60% to 100% of the individuals preserved urinary continence. Regardless of how it was assessed, erectile function after treatment varied between 33% and 100%. Conclusion: The results are really encouraging, especially with the more established techniques, with a larger target population and longer follow-up. Despite this observation, more studies will be required, mainly prospective and multicentric studies, with uniform criteria. With the increasing interest on minimally invasive therapies, focal therapies will probably be the future reality on treatment of the prostate cancer, mainly if localised and low grade.
Introduction: In the PSA era, the number of cases of localised prostate cancer has been increasing. This new reality requires for new therapeutic strategies, in order to give an answer to patients in whom active surveillance may be indicate but desire more interventive strategy. Actually, the radical approach of whole gland is the unique alternative to active surveillance. Thus, focal therapies can be an effective strategy in cancer control, minimizing side effects inherent to conventional therapeutic strategies. Goal: To assess the state of art related to the use of focal therapies on the treatment of localised prostate cancer, namely to know the characteristics of the target population, the methodologies used in the selection of the candidates, the side effects of the analysed techniques, the different follow-up modalities, and the outcomes related to disease control, preservation of urinary continence and erectile function. Methods: PubMed and ScienceDirect databases were used to the literature research. The articles analysed were published between 01/01/2004 and 31/12/2014. All studies were conducted in humans in whom the different modalities of focal therapy have been used as primary therapy. Results and Discussion: Thirty five studies where the focal therapies were used as primary treatment were analysed. Nine of them used HIFU, 11 cryotherapy, 3 photodynamic therapy, 6 laser therapy, 2 focal brachytherapy and 3 irreversible electroporation. Only one study included several ablation techniques, namely HIFU, cryotherapy, photodynamic therapy and focal brachytherapy. These studies encompassed a total universe of 2595 individuals, most of them with low to intermediate-risk disease, although some studies have included patients with high-risk disease. Follow-up lasted between 0 months and 18 years. To define biochemical disease-free survival were used several criteria, but the most used were the Phoenix and the ASTRO, although adapted to this approach. Between 0% to 33% of the patients had positive biopsy on treated area. Overall, 60% to 100% of the individuals preserved urinary continence. Regardless of how it was assessed, erectile function after treatment varied between 33% and 100%. Conclusion: The results are really encouraging, especially with the more established techniques, with a larger target population and longer follow-up. Despite this observation, more studies will be required, mainly prospective and multicentric studies, with uniform criteria. With the increasing interest on minimally invasive therapies, focal therapies will probably be the future reality on treatment of the prostate cancer, mainly if localised and low grade.
Description
Keywords
Braquiterapia Carcinoma da Próstata Crioterapia e Follow-Up Electroporação Irreverssível High-Intensity Focused Ultrasound Selecção Pacientes Terapêutica Focal Terapia A Laser Terapia Fotodinâmica