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Difference between revisions of "Prostate cancer"
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===Management=== | ===Management=== | ||
====Dirty first approximation==== | |||
The management changes between Gleason 6, 7 & 8; typically, the implications are: | The management changes between Gleason 6, 7 & 8; typically, the implications are: | ||
* Gleason 6: watchful waiting ''or'' radioactive seeds; surgery if patient wants. | * Gleason 6: watchful waiting ''or'' radioactive seeds; surgery if patient wants. | ||
* Gleason 7: do something - | * Gleason 7: do something - surgery ''or'' radiation therapy. | ||
* Gleason 8+: bad cancer - do something quickly! | * Gleason 8+: bad cancer - do something quickly! | ||
Bottom line: | Bottom line: | ||
*You want to be sure when you call something Gleason pattern 4. | *You want to be sure when you call something Gleason pattern 4. | ||
====Observational strategies==== | |||
*Delay of definitive treatment (surgery ''or'' radiation). | |||
*Common in management of prostate cancer. | |||
Usually divided into:<ref name=pmid23126653>{{Cite journal | last1 = Ip | first1 = S. | last2 = Dahabreh | first2 = IJ. | last3 = Chung | first3 = M. | last4 = Yu | first4 = WW. | last5 = Balk | first5 = EM. | last6 = Iovin | first6 = RC. | last7 = Mathew | first7 = P. | last8 = Luongo | first8 = T. | last9 = Dvorak | first9 = T. | title = An evidence review of active surveillance in men with localized prostate cancer. | journal = Evid Rep Technol Assess (Full Rep) | volume = | issue = 204 | pages = 1-341 | month = Dec | year = 2011 | doi = | PMID = 23126653 | url = http://www.ncbi.nlm.nih.gov/books/NBK83054/ }}</ref> | |||
*Active surveillance (AS). | |||
**Low risk of progression. | |||
*Watchful waiting (WW). | |||
**Higher risk of progression. | |||
Note: | |||
*Criteria for active surveillance vary widely.<ref name=pmid22314081>{{Cite journal | last1 = Palisaar | first1 = JR. | last2 = Noldus | first2 = J. | last3 = Löppenberg | first3 = B. | last4 = von Bodman | first4 = C. | last5 = Sommerer | first5 = F. | last6 = Eggert | first6 = T. | title = Comprehensive report on prostate cancer misclassification by 16 currently used low-risk and active surveillance criteria. | journal = BJU Int | volume = 110 | issue = 6 Pt B | pages = E172-81 | month = Sep | year = 2012 | doi = 10.1111/j.1464-410X.2012.10935.x | PMID = 22314081 }}</ref> | |||
=====Active surveillance===== | |||
==Microscopic== | ==Microscopic== | ||