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UNIVERSITATEA OVIDIUS DIN CONSTANA

FACULTATEA DE FARMACIE

Patologia tumoral
prostatei
COORDONATOR STIINIFIC
.L. UNIV. DR. DOICESCU DRAGO NICOLAE

ABSOLVENT
SABIUTA LARISA
CONSTANA
2015

Introducere
Cancerul de prostat este a doua cea mai frecvent
form de cancer n rndul brbailor la nivel mondial,
dar poate fi tratat n manier eficient atunci cnd este
detectat n stadiu iniial.
Scopul acestei lucrari este prezentarea generala a
formatiunilo tumorale ale prostatei punandu-se accent
pe adenomul de prostata si pe adenocarcinomul
prostatic. Partea personala consta in prezentarea
statistica a datelor culese de la Spitalul Clinic Judetean
de Urgenta Sf. Apostol Andrei Constanta, de pe
Sectia Clinic Urologie.
Motivatia alegerii acestei teme este convingerea
personala ca aceasta boala poate fi combatuta cu
succes si necesitatea de a aduce o contributie oricat de
mica la cresterea gradului de cunostinte despre
aceasta afectiune.

Anatomia prostatei

Vedere mediosagital a prostatei care arat raporturile

Anatomia prostatei

Uretera prostatic i membranoas

Clasificarea tumorilor maligne prostatice


A. Tumori
epiteliale

1.Adenocarcinoame (carcinoame primitive prostatice sau


adenocarcinoame convenionale)
2.Carcinoame cu celule tranziionale
Adenocarcinoame atipice
Ductale
Mucinoase (coloide)
Cu celule n inel cu pecete
Adenoscuamoase i scuamoase
Oncocitare
4.Carcinoame adenoid-chistice (bazaloide)
5.Carcinomul endometrial al utriculei prostatice
6.Tumori cu celule mici
Neuroendocrine
7.Tumori epiteliale rare
Carcinoame limfoepiteliom-like
Carcinoame sarcomatoide
Carcinoide

A. Carcinosarcoame
A. Tumori mezenchimatoase (sarcoame)
A. Tumori secundare
A. Tumori cu celule germinale
A. Tumori limfoide

Tumori benigne ale prostatei


BPH (Hiperplazia benign a prostatei) se dezvolt din
prostata tranziional, periuretral, ndeplinind
caracteristicile anatomice de formaiune periuretral,
supramontanal, prespermatic sau intrasfincterian
(n interiorul sfincterului neted).
Microscopic, nodulii sunt formai din hiperpiazie
stromal, fibro-adenomatoas, sau glandular, n toate
adenoamelede prostat existnd toate aceste
structuri,dar n proporii variabile

Adenom de prostat
evideniat microscopic

Manifestri clinice ale hiperplaziei


benigne a prostatei
Faza de prostatism:
Polakiurie nocturn moderat
Polakiurie nocturn moderat
Disurie marcat
Faza de retenie incomplet fr
distensie:
Apariia rezidiului vezical ce nu depete
capacitatea fiziologic a vezicii urinare
Faza de retenie incomplet cu
distensie:
Rezidiul depete capacitatea fiziologic

Manifestri clinice ale


adenocarcinomului prostatic

Manifestri locale:
Simptomatologie obstructiv
Simptomatologia iritativ
Hematuria
Hemospermia
Durerea loco-regional
Manifestri generale:
Osoase
Limfatice
Hepatice
Cerebrale

Diagnosticul cancerului de prostat

Tratamentul hiperplaziei benigne a


prostatei

Tratamentul chirurgical
Transuretrorezecia prostatei (TUR-P)
Transuretroincizia prostatei (TUI-P)
Adenomectomia deschis
Tratamentul medicamentos
Alfa-blocante Fenoxibenzamina, Prazosin, Alfuzosin,
Indoramin, Terazosin, Doxazosin, Tamsulosin.
Tratament hormonal Dihidrotestosteronul, Finasterida,
Mepartricina, Analogii GnRH, Antiandrogeni, Inhibitorii
de aromataze.
Fitoterapia - Pigenum africanum, Hypoxis rooperi,
Cucuibita pepo.

Tratamentul tumorilor maligne ale


prostatei

Boal localizat
Watchful waitng:
Prostatectomia radical:
Radioterapia curativ ( cu sau fr tratament hormonal
neoadjuvant)
Hormonal:
Terapii alternative: crioterapia.
Boala local avansat
Watchful waiting:
Prostatectomie radical:
Radioterapie:
Hormonal:
Boal recurent
Bola metastatic
Hormonal- terapie standard
Radioterapie n focar

Studiul Personal
Studiul personal a fost efectuat prin analizarea foilor
de observaie a pacienilor diagnosticai cu tumori ale
prostate din cadrul seciei Clinic Urologie a Spitalului
Clinic Judeean de Urgen Sntul Apostol Andrei
Constana, n colaborare cu Dr. Voinea Felix. Pacienii au
fost selectai din cei cei internai cu confirmarea
diagnosticului de adenom de prostat i cancer de
prostat n perioada 01 Septembrie 2014 01 Februarie
2015 pe secia Clinic Urologie. Datele au fost puse la
dispoziie sub acordul confidenialitii respectndu-se
normele etice i deontologice n vigoare.
Studiul personal are ca obictive:
Caracterizarea lotului de pacieni.
Distribuia pacienilor n funcie de stadiul bolii.
Evidenierea tratamentului aplicat.

Distrubuia pacienilor n funcie de diagnostic Distribuia pacienilor n funcie de vrst


20

20

24

18

25

15

16
20

16

Adeniom de prostat
Cancer de prostat

15

14
12

Total pacieni

Nur pacieni 10
8

10

6
5
0

4
2
Numr pacieni

Distribuia pacienilor cu adenom de prostat n funcie de vrst


12

10
9
8
7
6

10

Pacieni cu adenom
de prostat

6
4
2
0

70-80

Distribuia pacienilor cu cancer de prostat n funcie de vrst

10

Numr pacieni

60-69

10

13

14

50-59

1
50-59 60-69 70-80
Grupa de vrst

Numr pacieni

5
4
3
2
1
0

Pacieni cu cancer de
prostat

4
2

50-5960-6970-80

Grupa de vrst

Comparaia distribuiei n funcie de vrst a tuturor pacienilor


Pacieni cu adenom de prostat

Pacieni cu cancer de prostat

13

10

4
2
1

50-59

60-69

70-80

10

Distribuia pacienilor n funcie de mediul de via


Mediul Rural

Mediul Urban

35%
65%

Distribuia pacienilor n funcie de mediul de via


16

16
14

10

12
Numr pacieni

10

Mediul Rural
Mediul Urban

6
4
2
0

Sub-lotul A

Sub-lotul B

Cunotinele pacienilor cu privire la antecedente familiale legate de afeciunea lor


Numr total pacieni din sub-lot
Numa de pacieni cu cunotine despre antecedente familiale legate de afeciunea sa
24

16

11

Sub-lotul A (adenom de prostat)

Sub-lotul B (cancer de prostat)

Stadializarea clinic a adenomului de prostat


Stadiul I

Stadiul II

Stadiul III

4%
25%

71%

Stadializarea tumorilor maligne


T1c

T2

T3

6%

T3M1b

T4M1c

6%

19%
38%

31%

Tratamentul acordat pacienilor cu adenom de prostat


Tratamentu chirurgical

Tratament exclusiv farmacologic (Pazosin 4 mg/zi)

33%

67%

Repartizarea medicaiei la pacienii cu adenom de prostat tratai chirurgical


Finasterid 5 mg/zi Mepatricin 40 mg/zi

Numr pacieni

Abordul terapeutic la pacienii cu cancer de prostat

Prostectomie
laparoscopic radical +
flulamid 750 mg/zi
Estramustina+Vinblastin
+Paclitaxel
600mg+2mg+135mg
respectiv
Au refuzat terapia

Numr pacieni

11

10

12

Concluzii
Tumorile prostatei se pot prezenta n forme clinice variate, fiind at maligne ct i
benigne, fiecare necesitnd individualizarea terapiei.
Cea mai uzual metoda de diagnostic a afeciunilor prostatei este tueul rectal,
reprezentnd o tehnic sigur i ieftin de diagnostic.
Din punct de vedere farmacologic, terapia tumorilor prostatei se poate face cu
antagoniti alfa-1 n cazul tumorilor benigne si a hormonoterapiei testosteronice, sau
cu chimioterapia antineoplazic i teraie antiandrogenic n cazul tumorilor maligne.
Din punct de vedere chirurgical, prostectomia laparoscopic este modalitatea cea mai
utilizat de tratament pentru tumorile maligne ale prostatei.
Majoritatea pacienilor luai n studiu provin din mediu rural, fapt confirmat de
literatura de specialitate i explicat prin dieta mai bogat n grasimi a acestora ce are
o influen semnificativ asupra dezvoltrii afeciunilor prostatei.
Vrsta pacienilor are o inluen mare asupra dezvoltrii tumorilor prostatei, incidena
cea mai mare pentru tumorile benigne fiind ntre 60 si 69 de ani n timp ce incidena
cea mai crescut pentru tumorile maligne fiind ntre 70 i 80 de ani.
S-a putut constata o incliden mare a cazurilor de tumori maligne n stadiul T2 i T3la
pacienii luai n studiu.
Terapia farrmacologic a tumorilor maligne a inclus att tratament hormonal ct si
terapie chimioterapic anti-neoplazic.
Din nefericire, nu exist nc un tratament curativ complet pentru cancerul de
prostat sau pentru adenomul de prostat care sa nu implice riscurile prostectomiei si
reactiile sale adverse, dar prin cercetare este posibil descoperirea unor ageni
terapeutici noi ce vor conduce n timp la vindecarea lipsit de riscuri a acestei
afeciuni.

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