[Prostate cancer].
The Vall d'Hebron multidisciplinary prostate cancer (PC) team reviews recent advances in the management of this neoplasm. Screening studies with long follow-up show a reduction in mortality, whereas active surveillance is emerging as a therapeutic approach of non-aggressive cancers. New markers increase the specificity of PSA and also allow targeting suspected aggressive cancers. Multiparametric magnetic resonance (mMRI) has emerged as the most effective method in the selection of patients for biopsy and also for local tumor staging. The paradigm of random prostatic biopsy is changing through the fusion techniques that allow guiding ultrasonography-driven biopsy of suspicious areas detected in mMRI. Radical prostatectomy (RP) and radiotherapy (RT) are curative treatments of localized PC and both have experienced significant technological improvements. RP is highly effective and the incorporation of robotic surgery is reducing morbidity. Modern RT allows the possibility of high tumor dose with minimal adjacent dose reducing its toxicity. Androgen deprivation therapy with LHRH analogues remains the treatment of choice for advanced PC, but should be limited to this indication. The loss of bone mass and adverse metabolic effects increases the frequency of fractures and cardiovascular morbimortality. After castration resistance in metastatic disease, new hormone-based drugs have demonstrated efficacy even after chemotherapy resistance.
Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: jmorote@vhebron.net.
Joan
J
Morote
Servicio de Oncología Radioterápica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
Xavier
X
Maldonado
Servicio de Oncología Médica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
Rafael
R
Morales-Bárrera
D000230:Adenocarcinoma / Q000175:diagnosis / Q000628:therapy; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D009919:Orchiectomy; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy; D011878:Radiotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016879:Salvage Therapy; D018084:Ultrasonography, Interventional; D057832:Watchful Waiting
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
Cáncer de próstata; Diagnosis; Diagnóstico; Prostate cancer; Tratamiento; Treatment