Rak gruczołu krokowego o wysokim ryzyku progresji: skutki pominięcia zasad Evidence Based Medicine (EBM) i braku współpracy interdyscyplinarnej

Abstract Prostate cancer (PC) is currently a problem for urologists and oncologists because of the significant incidence increase which has been also reported in Poland (10,000 new cases). The biggest challenge for the therapeutic team is locally advanced PC because of its extra capsular extension and increased risk of metastases in pelvic lymph nodes. Treatment of PC should be considered with multidisciplinary approach (MTD). The benefits of therapeutic decision made by the MDT has been proven in many types of cancers, and for this reason in the United States and most EU countries this approach also for PC is a mandatory standard of treatment that contributes to better survival rates, higher satisfaction of patients and economic benefit. The medical history of a 61-year-old man with prostate cancer will be described. The cancer was diagnosed in April 2012, based on a biopsy of the prostate (Prostate Adenocarcinoma, Gleason score = 6, PSA = 32 ng/ml). The patient made a decision to be treated abroad. Patient was in the group of high risk disease progression and the standard treatment is radiation therapy combined with 2–3 years lasting hormonal therapy. Radical prostatectomy with extended lymph node dissection is recommended as an optional treatment for selected patients without fixation. Urologist made a choice to perform a robotic assisted radical prostatectomy. After surgery, there were indications in pathological report to perform adjuvant radiotherapy, however it was not considered. Nowadays a patient is prepared to receive a salvage treatment in the oncological centre in Poland but delay in treatment could have significant effect on his prognosis. The main conclusion is that even the most expensive and modern therapy such as robotic surgery without MTD approach and Evidence Based Medicine can result worse outcomes. In this case both the basic principles in oncology Evidence Based Medicine and MTD approach were not included.