Embolização - Prostate Cancer

Prostate Cancer

  • Introduction

  • Clinical Presentation

  • Diagnosis

  • Treatment

  • Prostatic Artery Chemoembolization

  • Follow up Control

    1. Introduction

A. Prostatic cancer (PCa) is the most frequent cancer in Europe in men over 70 years-old and the most commonly diagnosed non-skin cancer in men in the United States. PCa follows lung cancer in annual fatality rate, with a lifelong risk for diagnosis of 15.9%(1,2). Over 200.000 new cases are diagnosed each year with approximately one in every six U.S. men affected by the disease. Histology studies from autopsy series show that about 33% of men between 40 and 60 years-old have prostate cancer (3). The incidence of PCa increases with age and reaches 75% in men older than 85 years (4).

 

       2. Clinical Presentation

Prostate cancer may not have any clinical symptoms. Some cases may have urinary symptoms due to benign prostatic hyperplasia associated to prostate cancer. Elevated PSA may be the single suspicious sign of prostate cancer.

 

       3. Diagnosis

Any patient with high PSA should have a parametric magnetic ressonance. If this examen shows signs of a possible prostate cancer, prostate biopsy needs to be performed.

 

       4. Treatment

Radical prostatectomy (RP) is a curative treatment for localized PCa. Other curative treatments are external beam radiotherapy (EBRT) and brachytherapy. Alternative options to RP include hormonal therapy, watchful waiting and active surveillance (5-7).

         5.Prostatic Artery Chemoembolization

For those patients who refuse any treatment, prostatic artery chemoembolization is performed instead of the watchful waiting. For the purpose, under local anesthesia a catheter is placed percutaneously, under X-rays control, in the prostatic arteries. Following that, a cytostatic that is a cancer medication, is placed in the prostatic arteries. The procedure is finished by the embolization of those arteries by an embolic agent. Thus, the cytostatic medication will continue its action in the prostatic cancer.

 

          6.FU Control

 

PSA is performed every month up to 6 months and then every 3 months up to 1 year and then every 6 months. Parametric magnetic ressonance (pm RM) is performed at 6, 12 months and then yearly. Prostatic ultrasound is performed at 6, 12 months and then yearly. Six months after Chemoembolization, PSA and RM will show clear evidence of improvement of the tumor. Otherwise, the patient will be adviced to chose an alternative therapy. This is the advantage of chemoembolization. If the patient has chosen an alternative therapy to chemoembolization, this procedure can not performed.

 

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