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  • 1 Debreceni Egyetem, Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen, Nagyerdei krt. 98., 4032
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Összefoglaló. Bevezetés: Az utóbbi években az oligometastaticus prosztatadaganatok kezelése során a szisztémás kezelés mellett egyre gyakrabban végzik a primer tumor lokális kezelését is. Célkitűzés: A szerzők a tanulmányban a cytoreductiv radikális prostatectomia szerepét vizsgálták az oligometastaticus prosztatadaganatok kezelése során. Módszer: 2012. 01. 01. és 2019. 01. 01. között összesen hét betegben végeztek cytoreductiv radikális prostatectomiát oligometastaticus prosztatadaganat esetében. A betegek átlagos életkora 64 év, az átlagos PSA-koncentráció 43 ng/ml volt. Az áttétek száma minden beteg vonatkozásában maximum három volt, és valamennyi esetben csontáttét volt jelen. A betegek androgéndeprivatiós hormonkezelést kaptak, és közülük négy esetben már a műtét előtt elkezdték a hormonterápiát. Négy betegnél a csontmetastasisok miatt az áttétek sugárkezelése is megtörtént. Eredmények: A cytoreductiv prostatectomia szövettana öt esetben igazolt lokálisan előrehaladott (pT3) daganatot, és két alkalommal marginpozitivitás volt jelen. Emiatt öt beteg kapott adjuváns lokális irradiációt a metastasisok besugárzásán kívül. A műtétet követően biokémiai progresszió egy esetben jelentkezett. Ennek oka lokális recidíva volt, mely miatt a beteg ’salvage’ irradiációt kapott. Az átlagosan 38 hónapos utánkövetés során új metastasist nem diagnosztizáltak, és tumor okozta halálozás nem fordult elő. Következtetés: A cytoreductiv prostatectomia oligometastaticus prosztatarákos betegek kezelésében – válogatott beteganyagon – megvalósítható lehetőség. Ugyanakkor a cytoreductiv prostatectomia előnyei a tumorprogresszió szempontjából még nem egyértelműek, ennek eldöntéséhez további vizsgálatok szükségesek. Orv Hetil. 2021; 162(13): 483–487.

Summary. Introduction: In recent years, in addition to systemic therapy, local treatment of primary tumor has become increasingly common in the treatment of oligometastatic prostate cancers. Objectve: The authors measured the role of cytoreductive radical prostatectomy in the treatment of oligometastatic prostate carcinoma. Methods: From Janury 2012 to January 2019, they performed cytoreductive radical prostatectomy in seven patients with oligometastatic prostate cancer. The mean age of the patients was 64 years, and the mean PSA value was 43 ng/ml. The patients had maximum three distant metastases and all metastases were localized to the bones. The patients received androgene deprivation therapy and this treatment was started before the surgery in four cases. Irradiation of the bone metastasis was performed in four cases. Results: The histology of the cytoreductive radical prostatectomy showed locally advanced tumor (pT3) in five patients and margin-positive status was present in two cases. Hence, adjuvant irradiation was administered locally in five patients in addition to the irradiation of bone metastases. Biochemical progression was detected in one patient during the follow-up period. It was caused by local recurrence of the tumor and the patient was treated with salvage irradiation. During the 38 months follow-up period neither new distant metastasis nor cancer-related mortality was detected. Conclusion: The cytoreductive radical prostatectomy is a feasible option in selected cases with oligometastatic prostate cancer. However, the benefits of cytoreductive radical prostatectomy regarding tumor progression are not clear yet and further studies are required. Orv Hetil. 2021; 162(13): 483–487.

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