Incidentalni karcinom prostate u pacijenata liječenih zbog benigne hiperplazije prostate u periodu od 21 godine

The aim of this study was to determine the incidence of incidental prostate cancer and its clinical sig-nificance among patients who underwent transurethral prostate resection or transvesical adenomectomy for benign prostate hyperplasia at the Department of Urology in Sestre milosrdnice University Hospital Center from January 1997 to December 2017. A total of 277/4,372 (6.34%) patients from our cohort were diagnosed with incidental prostate cancer (mean age 74.5 years). Due to incomplete data, 12 patents were excluded from further analysis. 44.91% (119/265 patents) of our cohort were stage T1a and 55.09% (146/265) were stage T1b. Clinically significant prostate cancer was found in 168/265 patients (63.40%). When divided into two groups, Gleason score ≤6 (mean age 73.58 years) and Gleason score ≥7 (mean age 75.77 years), the results showed that Gleason score ≥7 patients were significantly older (p=0.0104) and that the tumor extent among patients in this group (mean = 34.58%) was higher than that in Gleason score ≤6 group (mean = 11.11%) (p=0.0169). More than a half of patients in our cohort had T1b stage prostate cancer. We found that 63.4% of carcinomas were clinically significant, with 52/265 (19,62%) patients affected by ISUP grade 4 and 5 cancers. Based on our research, we cannot give any recommendations regarding incidental prostate cancer treatment due to lacking preoperative (PSA, DRE) and follow-up data.Cilj ovog rada bio je utvrditi učestalost incidentalnog karcinoma prostate i klinički značaj istog u pacijenata podvrgnutih transuretralnoj resekciji prostate i transvezikalnoj prostatektomiji zbog benigne prostatične hiperplazije na Klinici za urologiju KBC-a „Sestre milosrdnice“ od siječnja 1997. do prosinca 2017. godine. Incidentalni karcinom prostate pronađen je kod 277/4,372 (6,34%) pacijenata iz naše studije (prosječna dob 74,5 godina). Zbog neadekvatnih podataka, 12 pacijentata isključeno je iz daljnje analize. 44,91% (119/265 pacijenata) nalazilo se u T1a stadiju, a 55,09% (145/265) u T1b stadiju bolesti. Klinički značajan karcinom pronađen je kod 168/246 pacijenata (60,40%). Kada se pacijenti podijele u dvije skupine, Gleason zbroj ≤6 (srednja dob 73,58 godina) i Gleason zbroj ≥7 (srednja dob 75,77 godina), rezultati pokazuju da su pacijenti s karcinomom prostate Gleason zbroja ≥7 statistički značajno stariji (p=0,0104) te da karcinom zahvaća veći dio pregledanog tkiva (prosjek= 34,58%) nego u bolesnika s karcinomom Gleason zbroja ≤6 (prosjek= 11,11%) (p=0,0169). U našoj studiji, više od polovice pacijenata s dijagnosticiranim karcinomom imalo je T1b stadij karcinoma prostate, 63,4% pacijenata imalo je klinički značajan karcinom, od čega je 52/265 (19,62%) pacijenata bolovalo od karcinoma ISUP stadija 4 i 5. Na temelju ovog istraživanja ne možemo dati preporuke o liječenju novodijagnosticiranog incidentalnog karcinoma prostate zbog insuficijentnih preoperativnih parametara (PSA, digitorektalni pregled) te nedostatnih podataka o postoperativnom praćenju tih pacijenata

Karcinom bubrežnog sabirnog kanala: prikaz triju slučajeva

Collecting duct carcinoma or Bellini duct carcinoma is a highly malignant neoplasm that arises from the collecting duct epithelium of the kidney and accounts for approximately 1% of renal neoplasms. Collecting duct carcinoma generally pursues a more aggressive course than conventional renal cell carcinoma. Metastases to regional lymph nodes, bone, adrenal glands, lung, skin and meninges have been reported. During the 1998-2000 period, 161 patients underwent nephrectomy due to renal cell carcinoma at our hospital. The patients’ age ranged from 24 to 90 (mean 59.5) years. There were 50 female and 111 male patients. Collecting duct carcinoma was diagnosed in three (1.9%) male patients aged 79, 66 and 67 (mean age 71.0) years. The patients presented with hematuria associated with fever, weight loss, pain and palpable abdominal mass. On gross examination, the tumors were located in the medulla of the kidney and extended into the cortex and adjacent adipose tissue. Histologically, the tumors showed tubulopapillary, tubular or solid areas. Immunohistochemically, positive staining with cytokeratin, EMA and Ulex Europaeus agglutinin was observed. All patients had regional lymph node metastases, and two of them died within one month from surgery. The third patient was alive and without signs of recurrence six months from presentation.Karcinom sabirnog kanala ili karcinom Bellinijeva kanala je visoko maligna neoplazma koja nastaje iz epitela bubrežnoga sabirnog kanala i čini otprilike 1% bubrežnih neoplazma. Karcinom sabirnoga kanala uglavnom ima agresivniji tijek od konvencionalnog karcinoma bubrežnih stanica. Opisane su metastaze u regionalne limfne čvorove, kosti, nadbubrežne žlijezde, pluća, kožu i meninge. U razdoblju od 1998. do 2000. godine u našoj je bolnici 161 bolesnik podvrgnut nefrektomiji zbog karcinoma bubrežnih stanica. Bolesnici su bili u dobi od 24 do 90 godina (srednja dob 59,5 godina), a bilo je 50 žena i 111 muškaraca. Karcinom sabirnog kanala dijagnosticiran je u trojice (1,9%) muških bolesnika u dobi od 79, 66 i 67 godina (srednja dob 71,0 godina). Bolesnici su došli s hematurijom udruženom s groznicom, gubitkom težine, bolovima i opipljivom masom u trbušnoj šupljini. Makroskopskim pregledom su tumori locirani u bubrežnoj meduli, a protezali su se u koru i obližnje masno tkivo. Histološki su tumori pokazivali tubulopapilarna, tubularna ili kruta područja. Imunohistokemijski je zabilježeno pozitivno bojenje citokeratinom, EMA i Ulex Europaeus aglutininom. Svi su bolesnici imali metastaze regionalnih limfnih čvorova, a dvojica su umrla kroz mjesec dana nakon operacije. Treći je bolesnik bio živ i bez znakova ponovljene bolesti šest mjeseci nakon dolaska u bolnicu

Epidemiologija raka prostate u Hrvatskoj - stanje i perspektive

Prostate cancer represents a significant public health burden in Croatia, as well as in other developed countries. The aim of this paper was to present the current epidemiological situation in Croatia in com-parison to other similar countries, using basic indicators such as incidence, mortality, prevalence and survival, and to discuss future possibilities in this field. The incidence of prostate cancer in Croatia has been rapidly increasing since the mid-nineties; recent data indicates that the trend is levelling off. Mortality data show constant increase since the 1960s, but mortality trends seem to be stabilizing in the recent period; however, Croatia is still in the top ten countries regarding prostate cancer mortality in Europe. Five-year prevalence in 2012 was estimated at 7,592 cases (426.7/100,000), ranking Croatia in the middle of European countries in the GLOBOCAN 2012 database. According to the CONCORD-2 study, five-year net survival in Croatia in the 2005-2009 period was 75.1%, which is lower than in similar European countries. The epidemiological pattern of prostate cancer in Croatia indicates a relatively low incidence, with significant room for improvement in mortality and survival data. Given the recent discussions regarding prostate cancer screening modalities, a debate is warranted and should be encouraged regarding the role of PSA testing in Croatia.Rak prostate predstavlja značajan javnozdravstveni problem, kako u Hrvatskoj, tako i u drugim razvijenim zemljama. Cilj ovog članka je prikazati trenutnu epidemiološku situaciju povezanu s rakom prostate u Hrvatskoj u usporedbi s drugim sličnim zemljama korištenjem osnovnih epidemioloških indikatora kao što su incidencija, mortalitet, prevalencija i preživljenje, te razmotriti koje su daljnje mogućnosti za poboljšanje istih. Incidencija raka prostate u Hrvatskoj je u značajnom porastu od sredine 90-tih godina; posljednji dostupni podaci ukazuju da je taj trend potencijalno dosegao plato. Podaci o mortalitetu pokazuju stalan rast od 1960-ih, no iako vidimo stabilizaciju tog trenda u posljednjem periodu, Hrvatska je i dalje među prvih deset zemalja u Europi po smrtnosti od raka prostate. Procijenjeno je da je petogodišnja prevalencija u 2012. iznosila 7.592 slučaja (426.7/100.000), što Hrvatsku smješta u sredinu europskih zemalja prema bazi podataka GLOBOCAN 2012. Petogodišnje preživljenje od raka prostate, prema istraživanju CONCORD-2, iznosi 75.1%, što je niže od preživljenja u nama sličnim europskim zemljama. Epidemiološki trendovi raka prostate u Hrvatskoj pokazuju relativno nisku incidenciju, dok prema podacima o mortalitetu i preživljenju vidimo da postoji mnogo mjesta za napredak. U svjetlu nedavnih diskusija o modelu ranog otkrivanja raka prostate, potrebno je održati i poticati raspravu o ulozi PSA testiranja u Hrvatskoj

Evolution of the Clinical Presentation and Outcomes after Radical Prostatectomy for Patients with Clinically Localized Prostate Cancer – Changing Trends over a Ten Year Period

We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period.We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ- confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ- confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted

Karcinom bubrežnog sabirnog kanala: prikaz triju slučajeva

Collecting duct carcinoma or Bellini duct carcinoma is a highly malignant neoplasm that arises from the collecting duct epithelium of the kidney and accounts for approximately 1% of renal neoplasms. Collecting duct carcinoma generally pursues a more aggressive course than conventional renal cell carcinoma. Metastases to regional lymph nodes, bone, adrenal glands, lung, skin and meninges have been reported. During the 1998-2000 period, 161 patients underwent nephrectomy due to renal cell carcinoma at our hospital. The patients’ age ranged from 24 to 90 (mean 59.5) years. There were 50 female and 111 male patients. Collecting duct carcinoma was diagnosed in three (1.9%) male patients aged 79, 66 and 67 (mean age 71.0) years. The patients presented with hematuria associated with fever, weight loss, pain and palpable abdominal mass. On gross examination, the tumors were located in the medulla of the kidney and extended into the cortex and adjacent adipose tissue. Histologically, the tumors showed tubulopapillary, tubular or solid areas. Immunohistochemically, positive staining with cytokeratin, EMA and Ulex Europaeus agglutinin was observed. All patients had regional lymph node metastases, and two of them died within one month from surgery. The third patient was alive and without signs of recurrence six months from presentation.Karcinom sabirnog kanala ili karcinom Bellinijeva kanala je visoko maligna neoplazma koja nastaje iz epitela bubrežnoga sabirnog kanala i čini otprilike 1% bubrežnih neoplazma. Karcinom sabirnoga kanala uglavnom ima agresivniji tijek od konvencionalnog karcinoma bubrežnih stanica. Opisane su metastaze u regionalne limfne čvorove, kosti, nadbubrežne žlijezde, pluća, kožu i meninge. U razdoblju od 1998. do 2000. godine u našoj je bolnici 161 bolesnik podvrgnut nefrektomiji zbog karcinoma bubrežnih stanica. Bolesnici su bili u dobi od 24 do 90 godina (srednja dob 59,5 godina), a bilo je 50 žena i 111 muškaraca. Karcinom sabirnog kanala dijagnosticiran je u trojice (1,9%) muških bolesnika u dobi od 79, 66 i 67 godina (srednja dob 71,0 godina). Bolesnici su došli s hematurijom udruženom s groznicom, gubitkom težine, bolovima i opipljivom masom u trbušnoj šupljini. Makroskopskim pregledom su tumori locirani u bubrežnoj meduli, a protezali su se u koru i obližnje masno tkivo. Histološki su tumori pokazivali tubulopapilarna, tubularna ili kruta područja. Imunohistokemijski je zabilježeno pozitivno bojenje citokeratinom, EMA i Ulex Europaeus aglutininom. Svi su bolesnici imali metastaze regionalnih limfnih čvorova, a dvojica su umrla kroz mjesec dana nakon operacije. Treći je bolesnik bio živ i bez znakova ponovljene bolesti šest mjeseci nakon dolaska u bolnicu

DIJAGNOSTIČKI ZNAČAJ BIOPSIJE PROSTATE VOĐENE KOGNITIVNOM FUZIJOM MULTIPARAMETRIJSKE MAGNETNE REZONANCE I TRANSREKTALNOG ULTRAZVUKA (mpmri-TRUS) KOD BOLESNIKA S PRETHODNO NEGATIVNOM TRUS VOĐENOM BIOPSIJOM

The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ≤ 3 (54%) could have avoided the biopsy.U ovoj prospektivnoj kliničkoj studiji cilj je odrediti stopu detekcije raka prostate biopsije vođene kognitivnom fuzijom multiparametrijske magnetne rezonance i transrektalnog ultrazvuka (mpMRI-TRUS) kod bolesnika s prethodno negativnom TRUS vođenom biopsijom. U razdoblju od 1. 10. 2016. do 1. 7. 2017. kod 101 uzastopnog bolesnika s povišenim prostata specifičnim antigenom (PSA) i/ili pozitivnim digitorektalnim pregledom, a nakon negativne prve TRUS biopsije je učinjena druga, ponovljena biopsija prostate. Kod 24 bolesnika učinjena je, u skladu sa Smjernicama Europskog urološkog društva, prethodna mpMRI i potom kognitivna fuzijska biopsija prostate s 8-10 sistemskih cilindara i 1-3 ciljane biopsije prema mpMRI nalazu. Kod 77 bolesnika je učinjena samo klasična, ponovljena TRUS biopsija bez prethodne slikovne obrade. Kod bolesnika s mpMRI, stopa detekcije raka prema PIRADSU-v2 je PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%) i PIRADS 5, n = 2/3 (67%). U skupini bolesnika s MR-TRUS kognitivnom fuzijskom biopsijom stopa detekcije raka prostate je 8/24 (33%), dok je u kontrolnoj skupini stopa detekcije 12/77 (16%), što se pokazalo statistički značajnom razlikom (t test; p=0.037, CI 95% je 0.01 to 0.37). Bolesnici s PIRADS ≤ 3 (54%) su mogli izbjeći biopsiju

Analiza isplativosti uvođenja biopsije prostate navođene multiparametrijskom magnetskom rezonancom

Continuous increase of the cost of medical services around the world has become a major topic in the world today. Multiparametric prostate MRI has recently become a new standard in prostate cancer detection, especially in repeated biopsy settings. The method, although superior in cancer detection rates, is costly and requires additional training and equipment. The purpose of our study was to determine the costs and benefits that arise when introducing this method in prostate cancer diagnostics. Repeated prostate biopsy was performed in 101 consecutive patients in the period from 1 October 2016 to 1 July 2017. Patients were divided into two groups based on whether prostate mp-MRI was performed or not. The prices of specific procedures were obtained from the billing service of the Sestre milosrdnice University Hospital Center and patient models were created to determine financial costs and benefits. The cost of the entire diagnostic process per patient in the non-MRI group was HRK 1.931,05 and HRK 1.848,42 in the mpMRI group, or 4.28% less. Prostate mpMRI and subsequent mpMRI guided biopsies can reduce the overall cost in prostate cancer diagnostics despite the procedure itself being an additional cost. This is achieved by omitting prostate biopsies in patients with low malignancy risk.Kontinuirani rast troškova medicinskih postupaka aktualna je tema i razlog zabrinutosti u cijelome svijetu. Ciljana, multiparametrijskim magnetom (mpMRI) navođena biopsija prostate polako postaje standard u dijagnostici karcinoma prostate, pogotovo kod ponovljene biopsije. Iako superiorna klasičnoj, sistemskoj biopsiji prostate, navedena metoda zahtijeva skupu dodatnu opremu i vješte, educirane kliničare. Naš cilj je analizirati ekonomsku isplativost uvođenja multiparametrijske magnetne rezonance prostate i posljedične kognitivno mpMRI-om navođene biopsije prostate u dijagnostički protokol bolesnika sa inicijalno negativnom sistemskom biopsijom prostate, kod kojih postoji daljnja klinička sumnja na karcinom prostate. U periodu od 01.10.2016. do 01.07.2017 kod 101 uzastopnog bolesnika s povišenim PSA i/ili pozitivnim DRP, a nakon negativne prve TRUS biopsije učinjena je druga, ponovljena biopsija prostate. Bolesnici su podijeljeni u dvije skupine ovisno o tome dali je učinjen mpMRI prostate ili ne. Učinjena je analiza broja i troškova posjeta specijalisti urologu kao i broja i troškova ordiniranih pretraga za svaku skupinu. Tijek kliničkih postupaka standardiziran je na temelju prosjeka za pojedine promatrane skupine te preračunat na 100 bolesnika za svaku skupinu radi lakše usporedbe rezultata. Kalkulacije su vršene na temelju dobivenih modela. Prosječna cijena obrade bolesnika u skupini bez mpMRI-a iznosi 1931,05 HRK dok u sa mpMRI-em iznosi 1848,42 HRK tj. 4,28% manje. Iako mpMRI prostate pojedinačno predstavlja značajan dodatan trošak u dijagnostici karcinoma prostate, kod bolesnika sa inicijalno negativnom biopsijom prostate isti omogućava velikom broju bolesnika izbjegavanje biopsije te posljedično smanjenje ukupnog troška

Povijest urologije u bolnici Sestara milosrdnica

The history of Croatian urology clearly shows its affiliation to the medical and civilizational circle of the Western world. The Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urology institution in the Republic of Croatia. The Department was established in 1894, when the new Sestre milosrdnice Hospital was open in Vinogradska cesta in Zagreb. It was then that doctor Dragutin Mašek founded the so-called III Department, which, in addition to treating urology patients, also treated patients with conditions of the ear, nose and throat, eye diseases and dermatologic conditions. Dragutin Mašek had already realized that medicine would soon be divided into fields and had assigned younger doctors joining the III Department to specific fields. As a result, urology was given to Aleksandar Blašković, who founded the first independent department of urology in Croatia in 1926. In 1927, he was appointed Professor of urology at the Zagreb School of Medicine, where he established the first department of urology and was giving lectures and practicals. Under his leadership, the Department of Urology was given the status of a Clinic, a teaching department, the first of its kind in Croatia. Owing to all his activities in the field of urology, the history remembers him as the “father of modern Croatian urology”. Over the course of the following years, department chairs had changed, but luckily for the patients, approach to work had not. Conscientiousness, trust, competence and charity. After all, charity is the idea that the hospital carries even in its name, after the Sisters of Charity who had founded it. In all the decades, the Department of Urology has been following global development paths, objectively legging behind top facilities in the world by only a few years. Overall professional and scientific urology activities culminated in 1998, when the Clinic became the Reference Center of the Ministry of Health of the Republic of Croatia for prostate cancer, and in 2011, when it became the European Board of Urology Certified Center. All that has been achieved could not have been done without wholehearted help and cooperation of the nurses, as well as every other department employee from the beginnings of urology until today. Despite its rich history, the Department does not rest on laurels. Today, it is a modern urology department together with its European role models.Prošlost hrvatske urologije jasno određuje njezinu pripadnost medicinskom i civilizacijskom krugu zapadnoga svijeta. Klinika za urologiju KBC “Sestre milosrdnice” najstarija je urološka ustanova u Republici Hrvatskoj. Osnovana je 1894. kad je otvorena nova Bolnica sestara milosrdnica u Zagrebu u Vinogradskoj ulici. Te je godine dr Dragutin Mašek osnovao tzv. III Odjel na kojem su se operativno zbrinjavali osim uroloških bolesnika, bolesnici sa bolestima uha, grla i nosa, sa očnim i dermatološkim bolestima. Dragutin Mašek već tada je vidio da će se medicina uskoro dijeliti na uža područja, pa je dolaskom mlađih liječnika na III. odjel njima prepuštao određena područja, tako da je urologiju preuzeo Aleksandar Blašković koji 1926. godine osniva prvi samostalni odjel za urologiju u Hrvatskoj. Imenovan je 1927. za profesora urologije na Medicinskom fakultetu u Zagrebu gdje osniva prvu katedru za urologiju i vodi predavanja i vježbe. Pod njegovim vodstvom Odjel za urologiju dobio 1943. godine status Klinike za urologiju, prve u Hrvatskoj. Temeljem svih tih aktivnosti na urološkom području povijest ga pamti kao „oca moderne hrvatske urologije“. U godinama koje slijede čelnici urologije su se mijenjali, a svjetonazor u radu na sreću bolesnika ne. Savjest, povjerenje, stručnost i milosrđe. Uostalom, to je znamen koji bolnica nosi u svom imenu. Svih tih desetljeća Klinika za urologiju je pratila suvremene svjetske pravce razvoja, objektivno kasneći tek nekoliko godina za vrhunskim ustanovama u svijetu. Cjelokupna stručna i znanstvena urološka djelatnost kulminira 1998. godine, kada Klinika postaje Referentni centar za tumore prostate Ministarstva zdravstva Republike Hrvatske i 2011. godine kada je postala Centar obuke Europskog odbora za urologiju (European Board of Urology). Sve postignuto ne bi se moglo ostvariti bez svesrdne pomoći i suradnje medicinskih sestara i drugih djelatnika klinike od prvih početaka urologije do današnjih dana. Unatoč bogatojj prošlosti, Klinika ne živi na uspjesima svojih prethodnika. Danas je ta urologija zajedno s njezinim uzorima europska moderna urologija

20 godina Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC Sestre milosrdnice

Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urological institution in the Republic of Croatia and this part of Europe. Today, the Department is a modern tertiary healthcare institution, where the most complex methods of urological practice are performed using modern medical devices and highly sophisticated technology. In 2011, our urology specialist education program was certified by the European Board of Urology (EBU) as the only one of its kind in Croatia. The program was recertified in 2017. The Department runs a program for the early detection of prostate cancer and performs more than 240 radical prostatectomies annually, which is the highest number of such interventions in Croatia. The aim of this study is to present the work and the activities of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center over the last 20 years. The database of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center was reviewed. During the twenty-year period, approx-imately 15,000 prostate interventions were performed due to benign and malignant diseases. Of this, 7,374 transrectal ultrasound guided prostate biopsies, 2,632 radical prostatectomies with open retropubic access, 3,988 transurethral prostate resections and 1,097 open suprapubic adenomectomies were performed. With the achieved scientific and professional results in monitoring, studying and improving the prevention, diagnosis and therapy of prostate tumors, as well as with the professional conditions and personnel, the Department of Urology in Sestre milosrdnice University Hospital Center truly justifies the title of the Reference Center for Prostate Tumors of the Ministry of Health of the Republic of Croatia awarded to it in 1998Klinika za urologiju Kliničkog bolničkog centra Sestre milosrdnice najstarija je urološka ustanova u Republici Hrvatskoj, a i u ovom dijelu Europe. Danas je Klinika za urologiju moderna medicinska ustanova tercijarne zdravstvene zaštite gdje se najsloženije metode urološke prakse izvode pomoću suvremenih medicinskih uređaja i visoko sofisticirane tehnologije. Program edukacije specijalizanata je 2011. godine certificiran od strane European Board of Urology (EBU) kao jedini takav u Hrvatskoj, a recertificiran je 2017. godine. U našoj se Klinici provodi program ranog otkrivanja raka prostate, a godišnje se obavlja preko 240 radikalnih prostatektomija što je ujedno i najveći broj takvih zahvata u Hrvatskoj. Cilj rada je prikazati rad i aktivnost Referentnog centra Ministarstva zdravstva za tumore prostate u Klinici za urologiju KBC „Sestre milosrdnice“ u posljednjih 20 godina. Učinjen je pregled baze podataka Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC „Sestre milosrdnice“. Tijekom dvadesetogodišnjeg razdoblja učinjeno je oko 15 000 zahvata na prostati zbog benignih i malignih bolesti. Od toga je učinjena 7 374 biopsija prostate vođene transrektalnim ultrazvukom, 2 632 radikalnih prostatekomija otvorenim retropubičnim pristupom, 3 988 transuretralnih resekcija prostate i 1 097 otvorenih suprapubičnih adenomektomija. Postignutim znanstvenim i stručnim rezultatima u praćenju, proučavanju i unaprjeđenju prevencije, dijagnostike i terapije tumora prostate kao i stručno-kadrovskim uvjetima, Klinika za urologiju KBC Sestre milosrdnice opravdava naslov Referentnog centra za tumore prostate Ministarstva zdravstva Republike Hrvatske koji nosi od 1998. godine

Epidemiology of Prostate Cancer in Croatia – Situation and Perspectives

Prostate cancer represents a significant public health burden in Croatia, as well as in other developed countries. The aim of this paper was to present the current epidemiological situation in Croatia in com-parison to other similar countries, using basic indicators such as incidence, mortality, prevalence and survival, and to discuss future possibilities in this field. The incidence of prostate cancer in Croatia has been rapidly increasing since the mid-nineties; recent data indicates that the trend is levelling off. Mortality data show constant increase since the 1960s, but mortality trends seem to be stabilizing in the recent period; however, Croatia is still in the top ten countries regarding prostate cancer mortality in Europe. Five-year prevalence in 2012 was estimated at 7,592 cases (426.7/100,000), ranking Croatia in the middle of European countries in the GLOBOCAN 2012 database. According to the CONCORD-2 study, five-year net survival in Croatia in the 2005-2009 period was 75.1%, which is lower than in similar European countries. The epidemiological pattern of prostate cancer in Croatia indicates a relatively low incidence, with significant room for improvement in mortality and survival data. Given the recent discussions regarding prostate cancer screening modalities, a debate is warranted and should be encouraged regarding the role of PSA testing in Croatia