Eficácia da vigilância ativa comparada com a prostatectomia radical em pacientes idosos com câncer de próstata localizado e de baixo risco: Revisão Sistemática
Eficácia da vigilância ativa comparada com a prostatectomia radical em pacientes idosos com câncer de próstata localizado e de baixo risco: Revisão Sistemática
Data
2018
Autores
Azevedo, Flávio da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
O objetivo do presente estudo é avaliar a eficácia e a segurança da vigilância ativa no tratamento do câncer de próstata localizado e de baixo risco em pacientes idosos em comparação com a prostatectomia radical. Os principais tratamentos para o Câncer de Próstata são a Prostatectomia radical, a Radioterapia, a Vigilância Ativa e a Conduta Expectante. O princípio da vigilância ativa é somente iniciar o tratamento, com intenção curativa, quando houver sinal de progressão da doença. Conduta reservada para tumores localizados com baixo risco de evolução, em pacientes com expectativa de vida de dez anos ou mais. Inclui consulta médica, exame de Antígeno Prostático Específico (PSA) trimestral e toque retal (DRE) semestral, além de biópsias transretais prostáticas realizadas anualmente. Foi realizada uma Revisão Sistemática de Literatura através de busca nas bases, COCHRANE, EMBASE, MEDLINE, SCOPUS, LILACS em 01 a 03 de Abril de 2018. Excluídos registros duplicados do mesmo estudo, utilizando o gerenciador de referências Rayyan. Extração de dados e a avaliação da qualidade realizada independentemente por dois autores. Os conflitos foram resolvidos com orientação de um mediador. Foram selecionados 436 ensaios clínicos randomizados, destes 135 eram duplicados, 218 relatos excluídos e 82 artigos com texto completo excluídos, com justificativa. Um único artigo atendeu os critérios de elegibilidade dos estudos. Em uma média de 10 anos, a mortalidade especifica por CaP foi baixa, independentemente do tratamento designado, sem diferença significativa entre os tratamentos. A prostatectomia radical foi associada com menores incidências de progressão da doença e metástases do que a vigilância ativa. Tivemos como limitações em nosso estudo, conceitos similares para Vigilância Ativa e Conduta Expectante, variando segundo autores ou grupo de pesquisa.
The aim of the present study is to evaluate the efficacy and safety of active surveillance in the treatment of localized and low-risk prostate cancer in elderly patients compared to radical prostatectomy. The main treatments for Prostate Cancer are Radical Prostatectomy, Radiation Therapy, Active Surveillance and Expectant Behavior. The principle of active surveillance is only to initiate treatment, with curative intent, when there is a sign of progression of the disease. Conduct reserved for localized tumors with a low risk of evolution in patients with a life expectancy of ten years or more. Includes medical consultation, quarterly Prostate Specific Antigen (PSA) and rectal examination (DRE) semester, in addition to prostate transrectal biopsies performed annually. A Systematic Review of Literature was carried out by searching the bases, COCHRANE, EMBASE, MEDLINE, SCOPUS, LILACS on 01 to 03 April 2018. Duplicate records of the same study were excluded, using the Rayyan reference manager. Data extraction and quality evaluation performed independently by two authors. The conflicts were resolved with the guidance of a mediator. A total of 436 randomized clinical trials were selected, of which 135 were duplicates, 218 excluded reports and 82 excluded full text articles, with justification. A single article met the eligibility criteria of the studies. In an average of 10 years, the specific mortality by CaP was low, independently of the designated treatment, without significant difference between the treatments. Radical prostatectomy was associated with lower incidences of disease progression and metastasis than active surveillance. We had as limitations in our study, similar concepts for Active Surveillance and Expectant Conduct, varying according to authors or research group.
The aim of the present study is to evaluate the efficacy and safety of active surveillance in the treatment of localized and low-risk prostate cancer in elderly patients compared to radical prostatectomy. The main treatments for Prostate Cancer are Radical Prostatectomy, Radiation Therapy, Active Surveillance and Expectant Behavior. The principle of active surveillance is only to initiate treatment, with curative intent, when there is a sign of progression of the disease. Conduct reserved for localized tumors with a low risk of evolution in patients with a life expectancy of ten years or more. Includes medical consultation, quarterly Prostate Specific Antigen (PSA) and rectal examination (DRE) semester, in addition to prostate transrectal biopsies performed annually. A Systematic Review of Literature was carried out by searching the bases, COCHRANE, EMBASE, MEDLINE, SCOPUS, LILACS on 01 to 03 April 2018. Duplicate records of the same study were excluded, using the Rayyan reference manager. Data extraction and quality evaluation performed independently by two authors. The conflicts were resolved with the guidance of a mediator. A total of 436 randomized clinical trials were selected, of which 135 were duplicates, 218 excluded reports and 82 excluded full text articles, with justification. A single article met the eligibility criteria of the studies. In an average of 10 years, the specific mortality by CaP was low, independently of the designated treatment, without significant difference between the treatments. Radical prostatectomy was associated with lower incidences of disease progression and metastasis than active surveillance. We had as limitations in our study, similar concepts for Active Surveillance and Expectant Conduct, varying according to authors or research group.
Description
Palavras-chave
Mortality, Prostatectomy, Active surveillance, Prostate cancer, Mortalidade, Prostatectomia, Vigilância ativa, Câncer de próstata
Citação
Azevedo FS. Eficácia da vigilância ativa comparada com a prostatectomia radical em pacientes idosos com câncer de próstata localizado e de baixo risco: Revisão Sistemática. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2018.