Tratamiento del cáncer de próstata en función de la esperanza de vida, la comorbilidad y las guías de práctica clínica / Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines

Fundamento: Describir el tratamiento de pacientes con cáncer de próstata en función de esperanza de vida, riesgo y comorbilidad, explorar el grado de seguimiento de las guías de práctica clínica (GPC) y registrar los efectos secundarios tras un año. Método: Estudio retrospectivo de pacientes diagnosticados y tratados de cáncer de próstata en un hospital el 2011. Se recogieron variables sociodemográficas, comorbilidad (índice de Charlson), del tumor, del tratamiento y efectos secundarios. Se realizó análisis bivariante con Ji cuadrado. Resultados: Se identificaron 114 pacientes. El 92,1% tenía esperanza de vida mayor de 10 años; el 50% comorbilidad baja, el 36% media y el 14% alta. Se practicó cirugía en el 56,2%, más en pacientes de riesgo medio y comorbilidad baja; radioterapia en el 13,2%, más en pacientes de riesgo alto y comorbilidad baja; hormonoterapia en el 21,9%, más en comorbilidad media, y tratamiento diferido en el 12,3%. El no seguimiento de la GPC alcanzó el 38,6% y en riesgo alto el 58,1%. El 70% de los tratados con cirugía presentaron incontinencia urinaria y el 48,3% disfunción eréctil. De los tratados con hormonoterapia, un 17,15% presentó enfermedades cardiovasculares y un 32,5% agravamiento de factores de riesgo cardiovascular. Conclusiones: El tratamiento del cáncer de próstata tiene en cuenta el riesgo y la comorbilidad, pero el seguimiento de las GPC puede mejorarse, principalmente en pacientes de riesgo alto. Es necesario adoptar medidas preventivas para reducir efectos secundarios cardiovasculares en pacientes sometidos a hormonoterapia (AU)

Background: To describe the treatment of prostate cancer patients according to life expectancy, risk and comorbidity, to examine the degree to which Clinical Practice Guidelines (CPG) are followed, and to register secondary effects after one year. Methods: Retrospective study of patients diagnosed with prostate cancer in a hospital in 2011. Socio-demographic variables, as well as comorbidity (Charlson index), tumor characteristics, treatments and secondary effects were collected. A bivariate analysis was performed using the Chi square test. Results: One hundred and fourteen patients were identified. Life expectancy was higher than 10 years in 92.1%; 50% had low comorbidity, 36% medium and 14% high. Surgery was performed in 56.2%, more often in patients with intermediate-risk and low comorbidity; radiotherapy in 13.2%, more often in patients with high-risk and low comorbidity; hormonal therapy in 21.9%, more often in patients with medium comorbidity, and deferred treatment in 12.3%. CPG recommendations were not followed in 38.6%, especially in high-risk patients, 58.1%. Regarding adverse effects, 70% of patients treated with surgery presented urinary incontinence, and 48.3% erectile dysfunction. On the other hand, 17.15% of patients treated with hormonal therapy presented a cardiovascular disease, and 32.5% worsening of a cardiovascular risk factor. Conclusions: Treatment of prostate cancer takes into account risk and comorbidity, but there could be improvement in following CPG guidelines, especially in elderly patients. It is advisable to develop preventive strategies to avoid cardiovascular effects in patients with hormonal therapy (AU)

[Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines]. / Tratamiento del cáncer de próstata en función de la esperanza de vida, la comorbilidad y las guías de práctica clínica.

BACKGROUND: To describe the treatment of prostate cancer patients according to life expectancy, risk and comorbidity, to examine the degree to which Clinical Practice Guidelines (CPG) are followed, and to register secondary effects after one year. METHODS: Retrospective study of patients diagnosed with prostate cancer in a hospital in 2011. Socio-demographic variables, as well as comorbidity (Charlson index), tumor characteristics, treatments and secondary effects were collected. A bivariate analysis was performed using the Chi square test. RESULTS: One hundred and fourteen patients were identified. Life expectancy was higher than 10 years in 92.1%; 50% had low comorbidity, 36% medium and 14% high. Surgery was performed in 56.2%, more often in patients with intermediate-risk and low comorbidity; radiotherapy in 13.2%, more often in patients with high-risk and low comorbidity; hormonal therapy in 21.9%, more often in patients with medium comorbidity, and deferred treatment in 12.3%. CPG recommendations were not followed in 38.6%, especially in high-risk patients, 58.1%. Regarding adverse effects, 70% of patients treated with surgery presented urinary incontinence, and 48.3% erectile dysfunction. On the other hand, 17.15% of patients treated with hormonal therapy presented a cardiovascular disease, and 32.5% worsening of a cardiovascular risk factor. CONCLUSIONS: Treatment of prostate cancer takes into account risk and comorbidity, but there could be improvement in following CPG guidelines, especially in elderly patients. It is advisable to develop preventive strategies to avoid cardiovascular effects in patients with hormonal therapy.