Compared with total embedding, partial embedding detected 98% of PCa with an ISUP grade Ink the entire RP specimen upon receipt in the laboratory, to demonstrate the surgical margins. Testicular cancer (TC) represents 5% of urological tumours affecting mostly younger males.
The survival advantage for both drugs appeared similar [The only candidates with metastasised disease who may possibly be considered for deferred treatment are asymptomatic patients with a strong wish to avoid treatment-related side-effects. The pooled sensitivity and specificity were 75% and 99% on a per lymph node (LN) basis and 77% and 97%, respectively, on a per patient basis [4]. A nadir < 0.5 ng/mL is associated with a favourable outcome after RT, although the optimal cut-off value remains controversial [Local recurrence after curative treatment is possible without a concomitant rise in PSA level [Imaging techniques have no place in routine follow-up of localised PCa as long as the PSA is not rising. Resolution of impairments in vulnerable men allows a similar urological approach as in fit patients.Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing, or swallowing difficulties?1 = able to get out of bed/chair but does not go outIn comparison with other people of the same age, how does the patient consider his/her health status?Figure 5.4.1: Decision tree for health status screening (men > 70 years)** Rating Score - Geriatrics; CGA = comprehensive geriatric assessment. Therefore, physicians should carefully interpret BCR end-points when comparing treatments.After RP, the threshold that best predicts further metastases is a PSA > 0.4 ng/mL and rising [After HIFU or cryotherapy no end-points have been validated against clinical progression or survival; therefore, it is not possible to give a firm recommendation of an acceptable PSA threshold after these alternative local treatments [Once a PSA relapse has been diagnosed, it is important to determine, whether the recurrence has developed at local or distant sites. It is essential to remember that breaking the link between diagnosis and active treatment is the only way to decrease over-treatment, while still maintaining the potential benefit of individual early diagnosis for men requesting it [Men at elevated risk of having PCa are those > 50 years [In addition, men with a PSA > 1 ng/mL at 40 years and > 2 ng/mL at 60 years are also at increased risk of PCa metastasis or death from PCa several decades later [The use of DRE alone in the primary care setting had a sensitivity and specificity below 60%, possibly due to inexperience, and can therefore not be recommended to exclude PCa [Multiple tools are now available to determine the need for a biopsy to establish the diagnosis of a PCa, including imaging by MRI, if available (see Section 5.2.4). Epub 2016 Aug 31.Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology.Eur Urol. Uncertainty around the effectiveness and value of these conservative interventions remains [The use of PDE5 inhibitors in penile rehabilitation has been subject to some debate.
2017 Apr;71(4):630-642. doi: 10.1016/j.eururo.2016.08.002. Offer radiation therapy alone if surgery is not appropriate.Offer apalutamide, darolutamide or enzalutamide to patients with M0 CRPC and a high risk of developing metastasis (PSA-DT < 10 months) to prolong time to metastases.The rationale for following up patients is to assess immediate- and long-term oncological results, ensure treatment compliance and allow initiation of further therapy, when appropriate. The risk of having positive LNs in intermediate-risk PCa is between 3.7-20.1% [Patients suitable for ADT can be given combined IMRT with short-term ADT (4-6 months) [Low-dose rate brachytherapy can be offered to highly selected patients (ISUP grade 2 with A prospective study on focal therapy using HIFU on patients with localised intermediate-risk disease was recently published [Data regarding the use of ADT monotherapy for intermediate-risk disease have been inferred indirectly from EORTC 30891 [Offer AS to highly selected patients (< 10% pattern 4) accepting the potential increased risk of further metastases.Offer RP to patients with intermediate-risk disease and a life expectancy of > 10 years.Offer nerve-sparing surgery to patients with a low risk of extracapsular disease.Perform an ePLND in intermediate-risk disease if the estimated risk for positive lymph nodes exceeds 5%.Offer low-dose rate brachytherapy to selected patients (see Section 6.2.3.2.3); patients without a previous transurethral resection of the prostate, with a good International Prostatic Symptom Score and a prostate volume < 50 mL.For external-beam radiation therapy (EBRT), use a total dose of 76-78 Gy or moderate hypofractionation (60 Gy/20 fx in 4 weeks or 70 Gy/28 fx in 6 weeks), in combination with short-term neoadjuvant plus concomitant androgen deprivation therapy (ADT) (4 to 6 months).In patients not willing to undergo ADT, use an escalated dose of EBRT (76-80 Gy) or a combination with brachytherapy.Only offer whole-gland ablative therapy (such as cryotherapy, high-intensity focused ultrasound, etc.) Adding MRI-TBx to systematic biopsy in biopsy-naïve patients increases the number of ISUP grade The diagnostic yield and number of biopsy procedures potentially avoided by the 'MR pathway' depends on the Likert/PI-RADS threshold used to define positive mpMRI.
Fixation can be enhanced by injecting formalin, which provides more homogeneous fixation and sectioning after 24 hours [Ensure total embedding, by conventional (quadrant) or whole-mount sectioning.Ink the entire surface before cutting, to evaluate the surgical margin.Examine the apex and base separately, using the cone method with sagittal or radial sectioning.The pathology report provides essential information on the prognostic characteristics relevant for clinical decision-making (Table 5.2.7.1).
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