BPH and CaP short

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  • :

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  • 3 McNeal 70% CaP 20% CaP 10% CaP

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  • PSA

  • - --

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  • () :50% 50 (25% )80% 80 (50% )

    1)2) DES3) -4)

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  • () 2
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  • IPSS International prostatic symptom score (1-7 , 8-19 , 20-35 ) (, , , , , )

    Nocturia 012345

    Not at allLess than 1 time in 5Less than half the timeAbout half the timeMore than half the timeAlmost alwaysIncomplete emptying 012345Frequency012345Intermittency012345Urgency012345Weak stream012345Straining012345

    Quality of life due to urinary symptomsDelightedPleasedMostly satisfiedMixed about equally satisfied and dissatisfiedMostly dissatisfiedUnhappyTerribleIf you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?0123456

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  • (, , , , ) ,

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  • , , 3 1/3

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  • - 1

    : , :

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    : , , , , , Floppy iris syndrome

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  • 5- ( )

    2: 1 2:

    ( 6 ), , V>50cc

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    : libido, , , , PSA ( screening)

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  • - + 5- IPSS

    + PVR, : , , ,

    + PDE-5 ( )

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  • () >60cc

    , 5-7 7-14% 10% 6% 0,25%

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  • TUR-P standard of treatment 2-3

    5% TUR-P 2,9% 2% 4%

  • EMERGING THERAPIES -plasma evaporation (TURIS) , TUR-syndrome,

    KTP laser (Greenlight) , ,

    Holep laser

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  • 2 2 3

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  • :

    : - : , , , , , , 2xR.R. 1 1 5-11x R.R. >1 1 . 9% ()

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  • 95%

    5%

    High grade Prostate intraepithelial neoplasia PINAtypical small acinar proliferation ASAP

    90% () Gleason score Gleason 3+3 < 3+4 < 4+3 < 4+4

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  • 3 McNeal 70% CaP 20% CaP 10% CaP

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  • 1. : , , 2. : / 60% 3.

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  • (, , ) LUTS, , , ), , ) , , , , (,)

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  • 18% PSA
  • PSA Prostate Specific Antigen 3 (kallikrein-3 KLK3) 1984 Stamey CaP 1994 FDA DRE

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  • PSA () :

    ( 4ng/ml, 2,5ng/ml)

    CaP DRE U/S

    DRE ()

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  • PSA DERIVATE TESTS PSA density ( PSA )PSA velocity ( PSA 1 )PSA doubling time ( )PSA ratio (free to total PSA) PSA

    f/t PSA 0,25 8 % CaP PSA 4-10 ng/ml DRE (-) CaP PSA >10 ng/ml

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  • o PSA 2 4

    PSA ASAP Atypical small acinar proliferation High grade Prostate intraepithelial neoplasia PIN

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  • () 10-12

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  • TO SCREEN OR NOT TO SCREEN (PSA + DRE) screening ( ) : test , , ,

    ERSPC Screening 13 : 781 screening 27 1 (1,28 1.000 ) 9 : 1.409 screening 48 1 9 follow-up

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  • , 2004-20101973-1993 screening

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  • DREPSATRUS - b : Gleason score - % core CT - mpMRI

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  • - (Transrectal ultrasound TRUS)Y 60-70% CaP20ng/ml):

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  • CT & MRIH (>10mm 40% )

    (multiparametric MRI)

    ( 67-98%) CaP Gleason MRI >1,5TOperator depended variability 2

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  • SCIN & PET CT

    PSA > 10 ng/ml , Gleason score 8, pT T3

    Fusion PET CT

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  • Low-risk (localised): T1-T2a, Gleason score 2-6, PSA < 10ng/ml

    Intermediate-risk (localised): cT2b-T2c, Gleason score = 7 PSA 10-20ng/ml

    High-risk (localised): cT3a Gleason score 8-10 PSA > 20ng/ml

    Very high-risk (localised): cT3b-T4, N0 T, N1

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  • Watchful waiting CaP -

    Active surveillance ( ) PSA DRE Gleason score

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  • : gold standard , +/- , +/- : , , +/- , - - : , , , : , , ,

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  • 0.0-2.1 1.0-11.5 0.0-5.4 0.0-8.3 0.8-7.7 1.0-3.0 , 0.3-15.4 4.0-50.0 0.0-15.4 29.0-100.0 0.5-14.6 0.0-0.7 2.0-9.0

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  • (EBRT external beam radiation)

    Three-dimensional conformal radiotherapy (3D-CRT) gold standardIMRT Intense modulated radiotherapy

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  • Low-risk (localised): < 50 cm3, IPSS 12 , TUR-P, , , . 40%

    +/- ADT , , , , ,

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  • DRE PSA = 2 PSA>0.2 ng/ml ..= SA> 2 ng/ml PSA 34% .. 5.8% .. CaP

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  • (
  • libido, , ,

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  • M < 50 ng/dlAbiraterone ( CYP-17)Enzalutamide

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  • Docetaxel 75mg/m2 3 + prednisone 5mg/Mitoxantrone + corticosteroids ( , )

    2 Cabazitaxel 25mg/m2 + prednisone 10mg/)EnzalutamideAbiraterone

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  • - Bisphosphonates (zoledronic acid): , ( )

    RANK ligand inhibitors (denosumab): RANKL (receptor activator of nuclear factor B ligand) , M0 CRPC,

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