University of Rijeka. Faculty of Medicine. Department of Urology.
Abstract
Karcinom prostate je najčešća maligna bolest među muškarcima u razvijenim zemljama, a druga prema mortalitetu. Među muškarcima starije životne dobi predstavlja jedan od vodećih javnozdravstvenih problema. U Hrvatskoj je drugi po učestalosti sa 18% i drugi uzrok smrtnosti muške populacije oboljele od karcinoma. Pacijenti najčešće niti ne znaju da imaju karcinom jer nemaju nikakve simptome. Dijagnostičke metode koje su dovele do sve češćeg otkrivanja karcinoma su: prostata specifični antigen u serumu, digitorektalni pregled i transrektalnim ultrazvukom vođena biopsija prostate. Biopsija je najbolja metoda, s obzirom da otkriva diferenciranost karcinoma i stupanj proširenosti bolesti. Pri liječenju lokaliziranog karcinoma u obzir dolaze konzervativne metoda i operativni postupak odnosno radikalna prostatektomija. U konzervativne metode ubrajamo aktivni nadzor, hormonsku terapiju i radioterapiju. Unatoč mogućnostima koje se pružaju, radikalna prostatektomija i dalje se smatra zlatnim standardom liječenja karcinoma prostate. Tijekom operacije uklanja se prostata, sjemeni mjehurići i limfni čvorovi. Iako su rezultati u vidu kontrole bolesti bolji nego kod konzervativnih metoda, inkontinencija i impotencija su česte specifične komplikacije. Zato je važan razvoj prostatektomije uz očuvanje neurovaskularnog snopa čime se uklanja tumor i održava neurovaskularni snop. Laparoskopska i robotska radikalna prostatektomija su minimalno invazivne metode kod kojih je smanjen gubitak krvi, kraći postoperativni oporavak manju bol i ožiljak. Postotak komplikacija je najveći kod laparoskopske, a najmanji kod robotske laparoskopske prostatektomije. Dulje je vrijeme potrebno za savladavanje laparoskopske tehnike, ali je bolja za pacijente, a rezultati su slični onima kod klasičnog pristupa.Prostate cancer is the most common malignant disease among men in developed countries and second in mortality. Among older men prostate cancer is one of the leading public health problems. In Croatia, it is second most frequent cancer with incidence of 18% and the second cause of the death of the male population suffering from cancer. In most cases, patients are not aware they have cancer because they have no symptoms. Diagnostic methods that have led to more frequent detection of cancer include: prostate specific antigen in serum, digitorectal screening and transrectal ultrasound-guided prostate biopsy. Biopsy is the best method, as it detects cancer differentiation and the extent of the disease's spread. In the treatment of localized cancer, conservative methods and operative procedures, or radical prostatectomy, come into consideration. Conservative methods include active monitoring, hormone therapy and radiotherapy. Despite the opportunities provided, radical prostatectomy continues to be considered the golden standard for prostate cancer treatment. During surgery, prostate, seminal vesicles and lymph nodes are removed. Although results in disease control are better than in conservative methods, incontinence and impotence are often specific complications. Therefore, an important improvement is prostatectomy with the preservation of the neurovascular bundle thereby removing the tumor and maintaining the neurovascular bundle. Laparoscopic and robotic radical prostatectomy are minimally invasive methods that reduce blood loss, postoperative recovery, pain and scar. The percentage of complications is greatest in laparoscopic and the smallest in robotic laparoscopic prostatectomy. Longer time is needed to overcome laparoscopic technique, but it is better for patients, and the results are similar to of classic approach
