Cáncer de Próstata

Descripción General

Epidemiología

• A nivel mundial:
  • 2do cáncer más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres
  • > 1.3 millones de casos diagnosticados anualmente
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos:
  • 3ra causa de cáncer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres
  • Aproximadamente 192 000 casos diagnosticados anualmente
  • El riesgo de ser diagnosticado de cáncer de próstata a lo largo de la vida es del 11%.
  • El riesgo de morir por cáncer de próstata a lo largo de la vida es del 2.5%.
• Supervivencia a los LOS Neisseria 5 años tras el diagnóstico:
  • Enfermedad localizada o propagación regional: casi el 100%.
  • Enfermedad metastásica distante: 31%

Factores de riesgo

Factores inherentes (principales):

• Edad
  • Raro en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres < 40 años de edad
  • Pico máximo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres entre 65 y 74 años de edad
• Más frecuente, y de aparición más temprana, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria afroamericanos
• Antecedentes familiares de cáncer de próstata, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum familiares de primer grado diagnosticados a < 65 años de edad
• Antecedentes familiares de otros cánceres hereditarios
  • Cáncer de mama, mutaciones de los LOS Neisseria genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure BRCA1 y BRCA2
  • Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma
  • Cáncer colorrectal, síndrome de Lynch
  • Cáncer de ovario
  • Cáncer de páncreas

Factores médicos:

• Obesidad
• Inhibidores de la 5-alfa-reductasa (e.g., finasterida)
  • ↓ Niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer
  • ↑ Riesgo de cáncer de próstata de alto grado
• Infección por Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles vaginalis

Factores sociales y ambientales:

• Dieta alta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum grasas y baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum vegetales
• Tabaquismo
• Exposición al AL Amyloidosis Agente Naranja
  • Herbicida y defoliante químico utilizado durante la guerra de Vietnam entre 1965 y 1972
  • Asociado a un cáncer más agresivo
• Exposición a la clordecona
  • Insecticida utilizado entre 1973 y 2003 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el Caribe
  • Se une a los LOS Neisseria receptores de estrógeno y contribuye a la malignidad

Fisiopatología

Glándula prostática y anatomía zonal

Glándula prostática:

• Es un órgano ubicado debajo de la vejiga
• Compuesto principalmente por tejido glandular que segrega líquido hacia el eyaculado (que constituye el semen, junto con los LOS Neisseria espermatozoides y el líquido seminal)

Anatomía zonal:

• Zona periférica:
  • Comprende > 70% de la glándula prostática
  • Aproximadamente el 70% de los LOS Neisseria cánceres de próstata se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la zona periférica.
  • Más cercana del recto
• Zona central:
  • 15%‒20% de los LOS Neisseria cánceres de próstata se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la zona central.
  • Rodea los LOS Neisseria conductos eyaculatorios
• Zona de transición:
  • 10%‒15% de los LOS Neisseria cánceres de próstata se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la zona de transición.
  • Rodea la uretra proximal
  • Área clave de preocupación para la hiperplasia prostática benigna (HPB)
• Estroma fibromuscular:
  • El cáncer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estroma fibromuscular es raro.
  • No contiene tejido glandular
  • Rodea el ápice de la próstata

Tumorigénesis

Bajo la influencia de los LOS Neisseria factores que se enumeran a continuación, epitelio prostático → neoplasia intraepitelial de próstata (lesión precursora) → adenocarcinoma localizado → metástasis y cáncer resistente a los LOS Neisseria andrógenos.

• El adenocarcinoma representa > 90% de los LOS Neisseria casos: se desarrolla principalmente a partir de una mutación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tejido glandular
• El desarrollo del cáncer de próstata se ve VE Ventilation: Mechanics of Breathing afectado por:
  • Factores ambientales
    • Dieta
    • Tabaquismo
  • Andrógenos
    • Las células del cáncer de próstata dependen de la testosterona para crecer y sobrevivir.
    • La dependencia de la testosterona se observa con la terapia antiandrogénica.
    • Se desarrollan mecanismos para superar el bloqueo androgénico y, finalmente, conducen a la resistencia a los LOS Neisseria andrógenos.
  • Factores genéticos heredados
    • Hay un ↑ riesgo 2 veces mayor en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres con familiares de primer grado con la enfermedad
    • Variantes germinales de MYC (oncogén del cáncer de próstata)
    • Otras variantes raras son el BRCA2 y los LOS Neisseria genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure reparadores de desajustes del ADN (parte del síndrome de Lynch).
  • Factores genéticos adquiridos
    • El gen de fusión TMPRSS-ETS es la alteración genética más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer de próstata (se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 50% de los LOS Neisseria casos).
    • Silenciamiento del gen que codifica p27 (una proteína que controla el crecimiento y la división celular)
    • Amplificación de MYC y deleción de PTEN: ↑ crecimiento celular y ↑ resistencia a los LOS Neisseria andrógenos

Presentación Clínica

• La mayoría de los LOS Neisseria pacientes diagnosticados se identifican mediante el tamizaje para el cáncer de próstata.
• Suele ser asintomática en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las primeras fases
• Manifestaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapas posteriores:
  • Dolor Dolor Inflammation óseo (sitio más común del cáncer de próstata diseminado)
  • Debilidad por compresión de la médula espinal
  • Pérdida de peso
  • Fatiga
  • Retención urinaria
  • Hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma
  • Disfunción eréctil
  • Hidronefrosis

Diagnóstico

Antígeno prostático específico

Los LOS Neisseria niveles de antígeno prostático específico se determinan para detectar un cáncer de manera precoz.

Contexto:

• Proteína producida por células de la próstata (pero no específica de malignidad)
• Una pequeña cantidad entra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el torrente sanguíneo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos sanos.
• ↑ Nivel del PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer sérico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer de próstata se debe a:
  • ↑ Número de células que producen PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer, a pesar de que las células malignas sintetizan menos PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer
  • Alteración de la arquitectura normal y de la membrana basal, que permite la entrada de ↑ niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el torrente sanguíneo

Interpretación:

• El PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer ≥ 4 ng/mL se considera positivo y es el estándar más aceptado, que logra el mejor equilibrio entre sensibilidad y especificidad.
• Uso prolongado de inhibidores de la 5-alfa-reductasa:
  • Asociado con ↓ niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer con el uso a largo plazo
  • Debe aplicarse un factor de corrección para una interpretación precisa.
  • Si hay ↑ del nivel de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer, el paciente debe ser derivado a urología.
• Otras condiciones urológicas que pueden elevar los LOS Neisseria niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer:
  • HPB
  • Prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis
  • Retención urinaria
  • Procedimientos urológicos (e.g., colocación de catéteres, cistoscopia)
• Se recomienda repetir las pruebas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de ↑ PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer (después de abordar los LOS Neisseria factores que pueden influir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la elevación)

Variables clínicas para interpretar los LOS Neisseria niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer:

• Los LOS Neisseria umbrales generales de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer (ng/dL) ajustados a la edad son los LOS Neisseria siguientes:
  • 40‒49 años: 2.5
  • 50‒59 años: 3.5
  • 60‒69 años: 4.5
  • 70‒79 años: 6.5
• Densidad del PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer:
  • Relación entre el PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer y el volumen de la próstata (medido mediante estudios imagenológicos)
  • Un valor ≥ 0.15 ng/mL/g es una indicación para la biopsia de próstata
• Velocidad del PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer:
  • El cáncer crece más rápido y el aumento de los LOS Neisseria niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer es más rápido.
  • Deben obtenerse al AL Amyloidosis menos 3 mediciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un periodo de 2 años.
• PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer libre y complejo:
  • 2 formas de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer: libre y unido a inhibidores de la proteasa
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer: ↑ PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer unido a inhibidores de la proteasa

Tacto rectal

• Ya no se recomienda para pacientes asintomáticos
• Baja sensibilidad y especificidad
• Sin embargo, si se detecta una anormalidad (e.g., nódulo, asimetría) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen rectal, debe realizarse una evaluación.

Biopsia de próstata

• Prueba de confirmación necesaria para el diagnóstico
• La biopsia se realiza mediante un abordaje transrectal guiado por imagen (ultrasonido transrectal o RM).
• Consideraciones antes de realizar una biopsia:
  • Edad y origen étnico del paciente
  • Esperanza de vida del paciente
  • Comorbilidades
  • Riesgos inmediatos y a largo plazo de la biopsia, y posibles opciones de tratamiento

Estudios imagenológicos

• Evaluación de la extensión del cáncer de próstata y determinación del volumen:
  • RM
  • Sistema de Datos e Informe en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Imagen Prostática ( PI-RADS PI-RADS Prostate Cancer, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Se utiliza para informar la probabilidad de cáncer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una zona sospechosa
    • Escala de 5 puntos, donde 1 representa una alta improbabilidad y 5 indica una alta probabilidad de cáncer
• Determinar la extensión extraprostática y la metástasis a distancia:
  • TC o RM de abdomen y pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy
  • PET PET An imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session. Nuclear Imaging: Las imágenes pueden superponerse con la TC y la RM.
  • Gammagrafía ósea

Estadificación

Parámetros

Los LOS Neisseria siguientes elementos son determinantes cruciales del resultado y se utilizan para la estratificación del riesgo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la selección de un enfoque terapéutico:

• Extensión del tumor Tumor Inflammation (T)
• Propagación a los LOS Neisseria ganglios (nódulos) linfáticos (N)
• Metástasis (M)
• Niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer antes del tratamiento
• Grupo de grado histológico (basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la puntuación de Gleason)

Estadificación de tumor-nódulos-metástasis

La estadificación TNM se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la 8va edición de las directrices de estadificación del American Joint Committee on Cancer. Hay dos categorías de estadificación:

1. Estadificación clínica: basada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen físico, las imágenes y la biopsia
2. Estadificación patológica: basada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hallazgos tras la prostatectomía

Clasificación histológica

Los LOS Neisseria grados se basan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la puntuación de Gleason.

• Medida estándar de diferenciación del cáncer de próstata
• 5 patrones puntuados del 1–5:
  • 1 es el más cercano al AL Amyloidosis tejido normal
  • 5 es el más anormal
• El espécimen de la biopsia se examina con poco aumento para identificar el patrón más común (1er número) y el segundo más común (2do número).
• Los LOS Neisseria 2 números se suman para obtener la puntuación de Gleason.
• La puntuación de Gleason se utiliza para predecir el comportamiento clínico y los LOS Neisseria resultados.
  • Grupo de puntuación y grado más bajo: Es probable que el cáncer crezca y se propague lentamente.
  • Grupo de puntuación y grado alto: Es probable que el cáncer crezca y se propague rápidamente.
  • El orden es tan importante como la puntuación total para predecir el pronóstico (e.g., 3 + 5 = 8 tiene un pronóstico más favorable que 5 + 3 = 8).

Estadio pronóstico

El estadio TNM, el PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer y el grado histológico pueden utilizarse para determinar el grupo de estadio pronóstico.

Estratificación del riesgo

La información relativa al AL Amyloidosis estadio del tumor Tumor Inflammation, el grado, la puntuación de Gleason y el nivel de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer se utilizan para determinar las categorías de riesgo clínico.

• El riesgo puede evaluarse como:
  • Muy bajo
  • Bajo
  • Intermedio
  • Alto
  • Muy alto
• Uso de guías de evaluación de riesgo:
  • Pertinencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la solicitud de estudios de imagen (e.g., no solicitar TC o gammagrafías óseas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes de muy bajo/bajo riesgo)
  • Opciones de tratamiento

Tratamiento

Principios del tratamiento

• El cáncer de próstata se asocia a un crecimiento lento y puede no ser clínicamente significativo durante la vida del paciente.
• Los LOS Neisseria tratamientos definitivos están asociados a importantes efectos secundarios que afectan la calidad de vida.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tratamiento se tienen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuenta múltiples factores:
  • Edad y esperanza de vida
  • Salud general y comorbilidades
  • Características del cáncer y estratificación del riesgo
  • Preferencias del paciente

Opciones de tratamiento

Vigilancia activa:

• Tratamiento diferido con seguimiento:
  • PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer seriados y tacto rectal a intervalos regulares
  • Repetir biopsias
  • RM
• Intención de tratamiento por progresión de la enfermedad o cambio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la preferencia del paciente
• Se prefiere en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con cáncer de muy bajo o bajo riesgo

Radioterapia (RT):

• RT de haz externo: puede causar disfunción eréctil y proctitis Proctitis Inflammation of the mucous membrane of the rectum, the distal end of the large intestine. Chronic Granulomatous Disease por radiación
• Braquiterapia:
  • Implantes de semillas radiactivas
  • Puede causar irritación de la vejiga

Cirugía (prostatectomía radical):

• Opciones:
  • Cirugía abierta
  • Laparoscopia con o sin asistencia robótica
• Extirpación de la próstata, vesículas seminales y ganglios linfáticos pélvicos, seguida de reconstrucción (reconexión del cuello de la vejiga y la uretra)
• Puede causar disfunción eréctil e incontinencia urinaria de esfuerzo

Terapia de privación de andrógenos ( ADT ADT Prostate Cancer, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):

• Agonistas de la hormona liberadora de hormona luteinizante (LHRH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):
  • Acetato de leuprolida, goserelina, triptorelina e histrelina
  • Liberación inicial/incremento de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, luego ↓ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle hipofisaria → ↓ testosterona
• Antagonistas de la LHRH:
  • Degarelix, relugolix
  • ↓ Actividad hipofisaria sin un aumento inicial de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ↓ testosterona.
• Antiandrógenos:
  • Antagonistas del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de andrógenos: flutamida, bicalutamida, apalutamida y enzalutamida
  • Inhibidores de la síntesis de andrógenos: abiraterona, ketoconazol y aminoglutetimida
• Castración quirúrgica con orquiectomía simple (extirpación de los LOS Neisseria testículos): ↓ niveles de testosterona
• Efectos secundarios generales:
  • Reducción del deseo sexual
  • Impotencia
  • Sofocos
  • Ginecomastia y sensibilidad mamaria
  • Depresión

Quimioterapia:

• Docetaxel Docetaxel A semisynthetic analog of paclitaxel used in the treatment of locally advanced or metastatic breast neoplasms and non-small cell lung cancer. Microtubule and Topoisomerase Inhibitors
• Cabazitaxel Cabazitaxel Microtubule and Topoisomerase Inhibitors

Inmunoterapia:

• Sipuleucel-T Sipuleucel-T An approved vaccine-based therapy for advanced (castration-resistant hormone-refractory) prostate cancer. First, there is an autologous dendritic cell preparation targeting prostatic acid phosphatase (PAP). Blood mononuclear cells are obtained via leukapheresis. Antigen-presenting cells are isolated and then activated in vitro by PAP fused to granulocyte macrophage colony-stimulating factor (GM-CSF). The reinfusion of the product produces T-cell activity against tumors expressing PAP. Cancer Immunotherapy ( Provenge Provenge An approved vaccine-based therapy for advanced (castration-resistant hormone-refractory) prostate cancer. First, there is an autologous dendritic cell preparation targeting prostatic acid phosphatase (PAP). Blood mononuclear cells are obtained via leukapheresis. Antigen-presenting cells are isolated and then activated in vitro by PAP fused to granulocyte macrophage colony-stimulating factor (GM-CSF). The reinfusion of the product produces T-cell activity against tumors expressing PAP. Cancer Immunotherapy)
  • Vacuna
  • Fabricado a partir de células mononucleares autólogas
  • Induce la inmunidad contra el cáncer de próstata
  • Para el cáncer de próstata metastásico resistente a la ADT ADT Prostate Cancer
• Pembrolizumab Pembrolizumab Squamous Cell Carcinoma (SCC):
  • Inhibidor del ligando 1 de muerte programada (PD-L1, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • Para los LOS Neisseria pacientes que carecen del mecanismo de reparación de desajustes (dMMR, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés), y para los LOS Neisseria individuos con altos niveles de inestabilidad microsatelital (MSI-H, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)

Otras terapias:

• Terapia dirigida
  • Inhibidores de la poli-ADP-ribosa polimerasa (PARP)
  • Para pacientes con una mutación germinal o somática de la reparación del ADN (BRCA)
• Radio-223
  • Emite radiación alfa
  • Previene las complicaciones debidas a las metástasis óseas

Tratamiento

Las siguientes opciones de tratamiento se basan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estadio pronóstico y deben seguirse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función de la edad, la salud y las preferencias del paciente:

• Estadio I:
  • Vigilancia activa (preferida)
  • RT o cirugía: se considera en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con una alta probabilidad de progresión
• Estadio II:
  • Vigilancia activa
    • Si no hay síntomas
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las personas mayores
    • Si los LOS Neisseria problemas de salud son graves
  • RT con o sin ADT ADT Prostate Cancer
  • Cirugía con o sin RT de haz externo
• Estadio III:
  • La recurrencia después del tratamiento es más probable.
  • RT de haz externo más ADT ADT Prostate Cancer: Se puede añadir braquiterapia.
  • Cirugía seguida por RT y/o ADT ADT Prostate Cancer
• Estadio IV:
  • Afectación de los LOS Neisseria ganglios linfáticos:
    • RT más ADT ADT Prostate Cancer
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos jóvenes con una mínima diseminación regional de los LOS Neisseria ganglios linfáticos, se puede considerar la cirugía seguida de ADT ADT Prostate Cancer con o sin RT.
  • Enfermedad metastásica: ADT ADT Prostate Cancer más quimioterapia
  • Otras opciones:
    • Cáncer resistente a la ADT ADT Prostate Cancer: inmunoterapia o inhibidores PARP
    • Metástasis ósea sintomática sin enfermedad visceral: radio-223

Diagnóstico Diferencial

• HPB: enfermedad causada por un aumento del número de células estromales y epiteliales dentro de la glándula prostática. Los LOS Neisseria pacientes suelen tener > 50 años y presentan síntomas de obstrucción y/o problemas de almacenamiento vesical. La hiperplasia prostática benigna puede provocar un aumento de los LOS Neisseria niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la anamnesis y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pruebas invasivas (cistoscopia, urodinamia, ultrasonido transrectal). El tratamiento es con medicamentos y/o cirugía.
• Prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis: grupo de afecciones inflamatorias de la glándula prostática. Los LOS Neisseria pacientes pueden ser asintomáticos o presentar síntomas urinarios, como dolor Dolor Inflammation perineal, aumento de la frecuencia urinaria y urgencia, obstrucción urinaria y fiebre. El diagnóstico es generalmente clínico y se apoya en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria resultados del análisis de orina y del cultivo. El tratamiento depende de la etiología, pero puede incluir antibióticos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de infección. Los LOS Neisseria niveles de antígeno prostático específico pueden ser elevados. Para diferenciar la prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis del cáncer de próstata, los LOS Neisseria niveles de PSA PSA A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. Prostate Cancer se vuelven a medir después del tratamiento de la prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis.
• Disfunción eréctil: incapacidad constante de adquirir o mantener una erección. La disfunción eréctil se asocia a diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus, enfermedades cardíacas y a ciertos medicamentos (e.g., antidepresivos). Los LOS Neisseria tratamientos para el cáncer de próstata (RT, prostatectomía) también pueden provocar disfunción eréctil. El tratamiento es con inhibidores de la fosfodiesterasa-5 y dispositivos de erección asistida por vacío.
• Incontinencia urinaria: fuga involuntaria de orina. Existen muchos tipos de incontinencia, como la de esfuerzo, la de urgencia y la mixta. La prostatectomía radical puede provocar una incontinencia urinaria de esfuerzo, que se presenta como una pérdida de orina con el esfuerzo o como incontinencia gravitacional. La intervención en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estilo de vida (ejercicios de Kegel), la terapia médica y los LOS Neisseria procedimientos quirúrgicos son opciones para el tratamiento de la incontinencia urinaria posquirúrgica.