RESUMO
Prostate cancer is the second most common cancer and the fi fth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The fi rst Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.
Assuntos
Consenso , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/terapia , Antineoplásicos/uso terapêutico , Brasil , Tomada de Decisão Clínica , Humanos , Masculino , Metástase Neoplásica , Neoplasias da Próstata/patologia , Sociedades MédicasRESUMO
INTRODUCTION: Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. OBJECTIVES: This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. MATERIALS AND METHODS: Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. RESULTS AND CONCLUSIONS: The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.
Assuntos
Consenso , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/terapia , Brasil , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/diagnósticoRESUMO
ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.
Assuntos
Humanos , Masculino , Neoplasias da Próstata/terapia , Guias de Prática Clínica como Assunto , Consenso , Neoplasias da Próstata/patologia , Sociedades Médicas , Brasil , Tomada de Decisão Clínica , Metástase Neoplásica , Antineoplásicos/uso terapêuticoRESUMO
ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.
Assuntos
Humanos , Masculino , Próstata/patologia , Consenso , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Brasil , Guias de Prática Clínica como AssuntoAssuntos
Dura-Máter , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Neoplasias Meníngeas/diagnóstico , Adulto , Antimetabólitos Antineoplásicos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Imuno-Histoquímica , Linfoma de Zona Marginal Tipo Células B/diagnóstico por imagem , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/terapia , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/terapia , Metotrexato/uso terapêutico , Convulsões/etiologia , Tomografia Computadorizada por Raios XRESUMO
O câncer de próstata é a segunda neoplasia mais freqüente em homens, e a utilização do PSA levou a um aumento no número de casos diagnosticados com doença clinicamente localizada. A recidiva bioquímica é a elevação dos níveis de PSA em pacientes submetidos a tratamento com finalidade curativa para a doença localizada, na ausência de sinais clínicos ou radiológicos de recidiva. Neste artigo revisa-se a recidiva bioquímica, ressaltando-se a sua definição, a história natural e a abordagem terapêutica dos pacientes a fim de individualizar a condução dos casos com base nas evidências disponíveis.
Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/prevenção & controle , Neoplasias da Próstata/terapia , RecidivaRESUMO
O acometimento metastático das leptomeninges e do líquor por células neoplásicas pode ser definido comocarcinomatose meníngea ou meningite carcinomatosa. Nos últimos 20 anos tem sido observado um aumentosignificativo da sua incidência, atribuído principalmente ao melhor controle da doença sistêmica com terapiasmais efetivas. A neoplasia mais freqüentemente associada à carcinomatose meníngea é o câncer de mama, seguidopelo câncer de pulmão e melanoma. A disseminação de células malignas pelo espaço sub-aracnóideo produz umasérie de sinais e sintomas neurológicos pleomórficos, caracterizados principalmente pelo acometimento de todosos níveis do neuroeixo. A suspeição clínica e o diagnóstico precoce são fundamentais para uma melhor preservação das funções neurológicas e da qualidade de vida. A presença de metástases leptomeníngeas de tumores sólidos é complicação associada a prognóstico reservado, com sobrevida mediana de 2 a 4 meses. O tratamento éessencialmente paliativo, incluindo radioterapia, quimioterapia intratecal e quimioterapia sistêmica. É crucial uma seleção adequada dos pacientes com maiores chances de se beneficiarem de um tratamento mais agressivo. Este artigo consiste numa revisão da literatura sobre este tema, feita através de pesquisa em banco de dados do MEDLINE de 1970 a 2002.