Aspectos práticos do tratamento do carcinoma localizado da próstata (T1/T2 ou A/B) / Localized prostate cancer: practical aspects of treatment (T10-T2 ou A/B)

RESUMO

The detection rates of localized prostate cancer have increased sifnificantly in recent years because of the routine prostate examination and PSA dosage. In this stage the perspective of cure or at least disease control is expected. There are two potential curative treatments for clinically localized prostate cancer radical prostatectomy and radiation therapy. For patients with life expectancy greater than 10 years and in good health status the surgical treatment, according to the majority of authors, seems to have more significant therapeutic benefits. It is important to point out that both the radiation sensitive and radiation resistant cell populations can be completely excised. Potential harm includes urinary incontinence and erectile dysfunction. On the other hand, for patients without those characteristics or who decline surgical approach, radiotherapy is recommended. The main drawback of this technique is that approximately 30 percent of clinically localized tumors countain cell clones that cannot be eradicated with therapeutic doses or radiation. Such patients have been documented to have a high incidence of subsequent distant metastases and persistently rising serum PSA levels. Interstitial radiation therapy has some attractive features, such as avoiding major surgery and the low rates of impotence and incontinence. Nevertheless, is not routinely applied because of the radiation resistent cell clones and the uneven distribution of radiation thet yields poor treatment results. With the newer branchytherapy techniques, long-term results are lacking. The potential harm or radiation includes cystitis, proctitis and erectile dysfunction...