Acta clinica Croatica
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Acta clinica Croatica · Nov 2019
ReviewTHE PROSTATE CENTER: MULTIDISCIPLINARITY, ORGANIZATION OF DIAGNOSTIC WORK-UP AND TREATMENT OF PROSTATE CANCER.
The aim of this paper is to show the results of prostate cancer treatment in Prostate Center of Department of Urology at the University Hospital Center Zagreb. The answer to growing demands for prostate cancer treatment due to increasing incidence is the formation of specialized, multidisciplinary units/centers that deal mainly with prostate cancer. ⋯ This new unit offers specialized and individualized approach to workup, treatment and follow up for prostate cancer patients based on multidisciplinarity. The Prostate Center was also established as a platform for education and research.
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Acta clinica Croatica · Nov 2019
ReviewIS TESTOSTERONE PROGNOSTIC IN PROSTATE CANCER TREATMENT? THE UROLOGICAL STANDPOINT.
Prostate cancer (PC) is known as an androgen-dependent tumor with testosterone as its natural growth factor, its action is mediated by the androgen receptor (AR) important for the biology and progression of PC. During aging a progressive decline in testosterone levels begins, caused by disability of aged Leydig cells to produce testosterone in response to luteinizing hormone. Surgical treatment of PC can influence the hypothalamic-pituitary-gonadal axis with less impact on it compared to patients treated with radiation. ⋯ These data show that there is no significant association between all sex hormone in men and lethal PC or total mortality. In patients with metastatic PC, results showed that elevation of baseline androstenedione levels was predictive of prostate-specific antigen (PSA) response; higher baseline androstenedione levels were associated with an improved overall survival. In these patients, the relationship between serum testosterone and PC prognosis varies in different clinical settings and according to androgen deprivation therapy administration.
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Acta clinica Croatica · Nov 2019
Case ReportsMANAGEMENT OF LOCALLY ADVANCED, AGGRESSIVE PROSTATE CANCER - CASE REPORT.
Treatment of locally advanced prostate cancer (PC) represents a challenge before multidisciplinary team (MDT), typically includes not only local disease control but also systemic therapy and it should be tailored to each individual patient. We present a case of a 58-year-old man, whose PC presented itself as a locally advanced disease. Bearing in mind the patients' age, absence of comorbidities but also his preferences, MDT decided that the rational first step in almost imminent multimodal treatment should be radical prostatectomy (RP). ⋯ The therapy was well tolerated, although there was one episode of transitory radiation cystitis roughly one year after its completion. After 45 months of follow-up the patient is without signs of biochemical recurrence of PC, with fully restored testosterone level and good quality of life. The main task in advanced PC management, through multidisciplinary approach, is providing good oncological outcome while trying to reduce treatment morbidity and to maintain a good quality of life.
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Acta clinica Croatica · Nov 2019
ReviewWHO SHOULD RECEIVE NOVEL HORMONAL THERAPY WITH ANDROGEN DEPRIVATION THERAPY IN METASTATIC HORMONE SENSITIVE PROSTATE CANCER?
Treatment with androgen deprivation (ADT) has for many years been a standard treatment for patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, several phase 3 randomized trials have completely changed the therapeutic approach for these patients. ⋯ Here we present an overview of the most important trials in this setting: STAMPEDE, LATITUDE, ARCHES, ENZAMET and TITAN in which abiraterone acetate, enzalutamide and apalutamide combined with ADT achieved significant improvement in overall survival of patients with mHSPC compared with ADT only. All three agents combined with ADT became new standard of therapy for this group of patients.