1. Preoperative local staging of prostate cancer : aspects on predictive models, magnetic resonance imaging and interdisciplinary teamwork
- Author
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Jäderling, Fredrik and Jäderling, Fredrik
- Abstract
In prostate cancer surgery the two issues at stake are the removal of the tumour on one hand and functional outcome i.e. urinary continence and sexual function on the other. A nerve preserving procedure will optimise the functional outcome but introduces the risk of positive surgical margins by accidentally leaving small tumour remnants behind, thus risking a poor oncological outcome. Preoperative knowledge of tumour aggressiveness, location and whether local growth is confined to the prostate is of outmost importance for an optimal outcome. Currently available tools that provide the surgeon with preoperative information on which to base the treatment decision and surgical technique are far from perfect. The overall aim of this thesis was to explore ways to improve preoperative local staging of prostate cancer, including the development of a prediction tool and the use of magnetic resonance imaging (MRI) in the decision of surgical method. In Paper 1 we found that of men who underwent surgery with preoperative characteristics implicating very low risk disease, one third had adverse pathology outcome i.e. non‐organ confined tumours and/or more aggressive tumour features at pathology. Sixteen percent had positive surgical margins and only 40% were urinary continent and sexually potent 12 months after surgery. The findings describe both the shortcomings of the preoperative work‐up and the risks linked to surgery. It also gives support to active surveillance, where active treatment is deferred, as an option for men with very low risk, albeit after careful risk stratification where MRI should play an important role to rule out maleficent tumours. Patients with tumour that on clinical examination are classified as organ‐confined will in approximately one third of the cases subsequently be reclassified at pathology as non‐organ confined. In Paper 2 the development of a prediction tool from preoperative variables, predicting non‐organ confined disease, is described. The acc more...
- Published
- 2016