Publication: Aceptación y resultados de la aplicación en España de un protocolo de vigilancia activa en cáncer de próstata
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2017-02-08
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Universidad Complutense de Madrid
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Abstract
Introducción. El cáncer de próstata es una parte del proceso de envejecimiento en varones. En los últimos años se ha incrementado el número de diagnósticos de bajo riesgo en los que el tratamiento radical podría significar un sobretratamiento. Sin embargo, algunos experimentan progresión de su enfermedad. El concepto de “Vigilancia Activa” implica el manejo conservador de estos pacientes con un seguimiento e identificación precoz de los casos potencialmente agresivos para plantear un tratamiento con intención curativa. La aplicación en nuestro medio de un protocolo de Vigilancia Activa generaba dudas en cuanto a la aceptación por parte de pacientes y a los resultados oncológicos. Tras 11 años desde su implementación disponemos de información para realizar un análisis de los resultados oncológicos, seguridad y eficacia de la aplicación en nuestro medio del protocolo de vigilancia activa en cáncer de próstata. Justificación. Hipótesis. Objetivos. El estudio se justifica por la necesidad de encontrar alternativas para evitar el sobretratamiento de los pacientes con cáncer de próstata de bajo riesgo. La hipotesis es que la aplicacíon en España de un protocolo de Vigilancia Activa es factible en cuanto a aceptación por los pacientes con buenos resultados oncológicos. El objetivo principal es conocer la supervivencia global, cáncer especifica, libre de metástasis y libre de tratamiento de los pacientes en vigilancia activa. Los objetivos secundarios son conocer el porcentaje de aceptación y abandono voluntario del protocolo, determinar cuales son los factores predictivos de reclasificación histológica, analizar los resultados de subgrupos de edad y de aquellos que no cumplen estrictamente los criterios de Vigilancia Activa y analizar los resultados de los tratamientos radicales realizados en la cohorte...
Introduction. Prostate cancer is a part of the aging process in men. The diagnosis of of lowarisk disease has increased in recent years. Due to the natural course of this condition it might well be that radical treatment were not superior to conservative management. In fact, few cases experience progression of their disease or have small focus of high grade. The concept of "active surveillance" involves the monitoring and early identification of potentially aggressive cases to deliver treatment with curative intent. At the time of starting the current study, the application of active surveillance generated doubts regarding the acceptance by patients and also in terms of the oncological results. With adequate followaup time we have gathered enough information to perform an analysis of the oncological outcomes , safety and the feasibility of the application of an active surveillance program of prostate cancer in Spain. Rationale. Hypothesis. Objectives. The hypothesis is that the application in Spain of an active surveillance protocol is feasible in terms of acceptance by the patients while providing adequate oncologic results. The main objective is to determine overall survival, canceraspecific survival, metastasisafree survival and treatmentafree survival of patients on active surveillance. Secondary objectives were to determine the rate of acceptance and voluntary refusal of the protocol, to identify which are the predictors of histological reclassification, analyze the results of subgroups of age and those who do not strictly meet the criteria for active surveillance and analyze results of the radical treatments performed in the cohort during the study...
Introduction. Prostate cancer is a part of the aging process in men. The diagnosis of of lowarisk disease has increased in recent years. Due to the natural course of this condition it might well be that radical treatment were not superior to conservative management. In fact, few cases experience progression of their disease or have small focus of high grade. The concept of "active surveillance" involves the monitoring and early identification of potentially aggressive cases to deliver treatment with curative intent. At the time of starting the current study, the application of active surveillance generated doubts regarding the acceptance by patients and also in terms of the oncological results. With adequate followaup time we have gathered enough information to perform an analysis of the oncological outcomes , safety and the feasibility of the application of an active surveillance program of prostate cancer in Spain. Rationale. Hypothesis. Objectives. The hypothesis is that the application in Spain of an active surveillance protocol is feasible in terms of acceptance by the patients while providing adequate oncologic results. The main objective is to determine overall survival, canceraspecific survival, metastasisafree survival and treatmentafree survival of patients on active surveillance. Secondary objectives were to determine the rate of acceptance and voluntary refusal of the protocol, to identify which are the predictors of histological reclassification, analyze the results of subgroups of age and those who do not strictly meet the criteria for active surveillance and analyze results of the radical treatments performed in the cohort during the study...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 20/01/2016