Current knowledge about prostatic cancer a proposal for a common therapy protocol

Ukupna učestalost karcinoma prostate znatno premašuje učestalost klinički dokazanog karcinoma, iako je to najčešći rak u muškaraca. Dijagnoza kliničkog raka prostate postavlja se danas na osnovi sigurnih i neizbježnih pokazatelja. To su: rektalni pregled, UZV pregled transrektalnom sondom, povišene vrijednosti prostatičnog specifičnog antigena (PSA) u serumu i transrektalna punkcijska biopsija. Suvremena klasifikacija mora odvojiti lokaliziranu bolest od uznapredovale i diseminirane bolesti. Kako veliki dio karcinoma prostate predstavlja stacionarnu bolest, potrebno je utvrditi prediktore malignog potencijala s pomoću kojih će se odvojiti slučajevi agresivnog karcinoma koji zahtijevaju terapiju. To su: povećanje limfnih čvorova zdjelice, povišeni PAP, veličina primarnog tumora, niskodiferencirani epitel primarnog tumora i stanična aneuploidija. Lokalizirani agresivni karcinom prostate, uz ispunjene opće uvjete operacije, zahtijeva radikalnu prostatektomiju. Uznapredovali karcinom ili diseminirana bolest diktiraju kombiniranu terapiju kojoj je osnova potpuna androgena blokada. To se u prvoj fazi terapije postiže orhidektomijom + analozi GnLH + antiandrogeni. Druga se faza terapije osniva na fosforiliziranim esterima stilbena (Honvan i Estracyt), treća na citostaticima i posljednja na suzbijanju boli.General frequency of prostatic cancer (including incidental and undetected) outnumbers clinical prostatic cancer, although this one is by far the most frequent cancer of man. Current diagnosis of clinical prostatic cancer is based on digital examination, rectal ultrasound, serum prostatic specific antigen level and transrectal biopsy. Modern classification has to separate localized from advanced and disseminated disease. A high percent age of prostatic cancer is inactive disease whose mortality does not outnumber the man lethality without cancer. Today, we have some concrete factors indicating the disease aggressive potential, e.g. regional lymph node growth, high PSA and PAP levels, primary tumor size, high grading and nuclear aneuploidy. With them, the cases requiring therapy can be differentiated from those with inactive cancer. Localized aggressive prostatic cancer with general conditions for operation fulfilled indicates radical prostatectomy. The advanced and disseminated disease is an indication for paliative therapy, which is based on complete androgen deprivation. This is achieved in the first phase of therapy with orchydectomy + GnLH analogues + antiandrogens. The next therapeutic phase (after new disease progression ) consists of phosphorilized stilbens, such as Estracyt and Honvan. The final, exclusively symptomatic therapy should be preceded by chemotherapy