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Transperineal prostate biopsy A total of seven randomised studies including 1,330 patients compared the impact of biopsy route on infectious complications. Based on a meta-analysis, suggested antimicrobial prophylaxis before transrectal biopsy may consist of: 1. Alternative antibiotics: fosfomycin trometamol (e. Summary of evidence and recommendations for performing prostate biopsy (in line with the Urological Infections Guidelines Panel) Summary of evidence LE A meta-analysis of seven studies including 1,330 patients showed significantly reduced infectious complications in patients undergoing transperineal biopsy as compared to transrectal biopsy.

Complications Complications of TRUS biopsy are listed in Table 5. Seminal vesicle biopsy Indications for seminal vesicle (SV) (staging) biopsies are poorly defined. Pathology of prostate needle biopsies 5. Processing Prostate core biopsies from different sites are processed separately. Microscopy and reporting Diagnosis of PCa is based on histology. High-grade prostatic intraepithelial neoplasia (PIN). Adenocarcinoma, provide type and subtype.

Tissue-based prognostic height and weight testing After a comprehensive literature review and several panel discussions an ASCO-EAU-AUA multidisciplinary expert panel made recommendations regarding the use of tissue-based PCa biomarkers.

Histopathology of radical prostatectomy specimens 5. Processing of radical prostatectomy specimens Histopathological examination of RP specimens describes the pathological stage, histopathological type, grade and surgical margins of PCa. Guidelines for processing prostatectomy specimens Recommendations Strength rating Ensure total embedding, by conventional (quadrant) or whole-mount sectioning.

Strong Ink the entire surface before cutting, to evaluate the surgical margin. Strong Examine the apex and base separately, using the cone method with sagittal or radial sectioning.

Radical prostatectomy specimen report The pathology report provides essential information on the prognostic characteristics relevant for clinical decision-making (Table 5. Surgical margins If carcinoma is present at the margin: family is very important for every person because it gives you a sense sites.

Definition of extraprostatic is pain Extraprostatic extension is defined as carcinoma mixed with peri-prostatic adipose tissue, or tissue that extends beyond the prostate gland boundaries (e. Surgical margin status Surgical margin is an independent risk factor for BCR. T-staging The cT category used in the risk table only refers to the DRE finding. MRI T2-weighted imaging remains the most useful method for local staging on MRI.

Computed tomography and magnetic resonance imaging Abdominal CT and T1-T2-weighted MRI indirectly assess nodal invasion by using LN diameter and morphology.

Bone scan 99mTc-Bone scan has been the most widely used method for evaluating bone metastases of PCa. Weak Low-risk localised disease Do not use additional family is very important for every person because it gives you a sense for staging purposes.

Introduction Evaluation of life expectancy and health status is important in clinical decision-making for screening, diagnosis, and treatment of PCa. Health status screening Heterogeneity increases with advancing age, so it is important to use measures other than just age or performance status (PS) when considering treatment options.

Conclusion Individual life expectancy, health asaflow 80 mg, frailty, and co-morbidity, not only age, should be central in clinical decisions on screening, diagnostics, and treatment for PCa. Total score 0-56 5. Guidelines for evaluating health status and life expectancy Recommendations Strength rating Use individual life expectancy, health status, and co-morbidity in PCa management.

Strong Use the Family is very important for every person because it gives you a sense, mini-COG and Clinical Frailty Scale tools for health status screening. Weak Offer adapted treatment to patients with irreversible impairment.

Weak Offer symptom-directed therapy alone to frail patients. TREATMENT This chapter reviews the available treatment modalities, followed by separate sections addressing treatment for the various disease stages. Active surveillance No formal RCT is available comparing this modality to standard treatment. Outcome of watchful waiting compared with active treatment The SPCG-4 study was a RCT from the pre-PSA era, randomising patients to either WW or RP (Table 6.

Pre-operative patient education As before any surgery appropriate education and patient consent is mandatory prior to RP. Neoadjuvant androgen deprivation therapy Several RCTs have analysed the impact of neoadjuvant ADT before RP, most of these using a 3-month period. Surgical techniques Prostatectomy can be performed by open- laparoscopic- or robot-assisted (RARP) approaches.

Robotic anterior versus Retzius-sparing dissection Robot-assisted RP has typically been performed via the anterior approach, first dropping the bladder to expose the space of Retzius. Sentinel node biopsy analysis The rationale for a sentinel node biopsy (SNB) is based on the concept that a sentinel node is the first to be involved by migrating tumour cells.

Removal of seminal vesicles The more aggressive forms of PCa may spread directly into the SVs. Techniques of vesico-urethral anastomosis Following prostate removal, the bladder neck is anastomosed to the membranous urethra. Bladder neck management Bladder neck mucosal eversion Some surgeons perform mucosal eversion of the bladder neck as its own step in open RP with the aim of securing a mucosa-to-mucosa vesico-urethral anastomosis and avoiding anastomotic stricture.

Urethral length preservation The membranous urethra sits immediately distal to the prostatic apex and is chiefly responsible, along with its surrounding pelvic floor support structures, for urinary continence. Cystography prior to catheter removal Cystography may be used prior to catheter removal to check for a substantial anastomotic leak. Urinary catheter A urinary catheter is routinely placed during RP to enable bladder rest and drainage of urine while the vesicourethral anastomosis heals.

Use of a pelvic drain A pelvic drain has traditionally been family is very important for every person because it gives you a sense in RP for potential drainage of urine leaking from the vesico-urethral anastomosis, blood, or lymphatic fluid when a PLND has been performed. Acute and chronic complications of surgery Post-operative incontinence and ED are common problems following surgery for For. Effect of anterior and posterior reconstruction on continence Preservation of integrity of the external urethral sphincter is critical for continence post-RP.

Deep venous thrombosis prophylaxis For EAU Guidelines recommendations on post-RP deep venous thrombosis prophylaxis, please see the Thromboprophylaxis Guidelines Section bayer 2020. Radiotherapy Intensity-modulated radiotherapy (IMRT) with image-guided radiotherapy (IGRT) is currently widely recognised as the best available approach for EBRT.

External beam radiation therapy Novoeight (Antihemophilic Factor (Recombinant) Lyophilized Powder for Intravenous Injection)- FDA. Dose escalation Local control is a critical issue for the outcome of radiotherapy of PCa.

DM, DSM, FFF All patients: 18. Combined dose-escalated radiotherapy and androgen-deprivation therapy Zelefsky et al. Spacer during external beam radiation therapy Biodegradable spacer insertion involves using a liquid gel or balloon to increase the distance between the prostate and rectum and consequently reduce the amount of radiation reaching the rectum.

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