Navigating the evolving diagnostic and therapeutic landscape of low- and intermediate-risk prostate cancer.

Asian journal of andrology Pub Date : 2024-11-01 Epub Date: 2024-05-03 DOI:10.4103/aja20249
Fabio Zattoni, Fabio Matrone, Roberto Bortolus, Gianluca Giannarini
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Abstract

Abstract: In this nonsystematic review of the literature, we explored the changing landscape of detection and treatment of low- and intermediate-risk prostate cancer (PCa). Through emphasizing improved cancer assessment with histology classification and genomics, we investigated key developments in PCa detection and risk stratification. The pivotal role of prostate magnetic resonance imaging (MRI) in the novel diagnostic pathway is examined, alongside the benefits and drawbacks of MRI-targeted biopsies for detection and tumor characterization. We also delved into treatment options, particularly active surveillance for intermediate-risk PCa. Outcomes are compared between intermediate- and low-risk patients, offering insights into tailored management. Surgical techniques, including Retzius-sparing surgery, precision prostatectomy, and partial prostatectomy for anterior cancer, are appraised. Each technique has the potential to enhance outcomes and minimize complications. Advancements in technology and radiobiology, including computed tomography (CT)/MRI imaging and positron emission tomography (PET) fusion, allow for precise dose adjustment and daily target monitoring with imaging-guided radiotherapy, opening new ways of tailoring patients' treatments. Finally, experimental therapeutic approaches such as focal therapy open new treatment frontiers, although they create new needs in tumor identification and tracking during and after the procedure.

驾驭不断变化的中低风险前列腺癌诊断和治疗方法。
摘要:在这篇非系统性的文献综述中,我们探讨了低危和中危前列腺癌(PCa)检测和治疗的变化情况。通过强调组织学分类和基因组学对癌症评估的改进,我们研究了 PCa 检测和风险分层的主要进展。我们研究了前列腺磁共振成像(MRI)在新型诊断途径中的关键作用,以及磁共振成像靶向活检在检测和肿瘤特征描述方面的优点和缺点。我们还深入探讨了治疗方案,尤其是对中危 PCa 的积极监控。我们对中危和低危患者的治疗效果进行了比较,为有针对性的治疗提供了启示。我们还对手术技术进行了评估,包括保留前列腺手术(Retzius-sparing surgery)、精确前列腺切除术(precision prostatectomy)和前列腺癌前列腺部分切除术(partial prostatectomy for anterior cancer)。每种技术都有可能提高疗效,减少并发症。技术和放射生物学的进步,包括计算机断层扫描(CT)/核磁共振成像(MRI)成像和正电子发射断层扫描(PET)融合,使成像引导的放射治疗可以进行精确的剂量调整和日常靶点监测,开辟了为患者量身定制治疗方案的新途径。最后,病灶治疗等实验性治疗方法开辟了新的治疗领域,但在治疗过程中和治疗后的肿瘤识别和跟踪方面也提出了新的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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