??S?????S G. ??G????????S

1
??T?S??S ??? ???S????

• ??S?????S G. ??G????????S
• ???????G?S ??????G?S

2
?? ????? ? ???S????S

• ?d??a? se µ??e??? ??sta???
• ???s?eta? µp??st? ap? t?? ????d??? ??st? ?a?
  pe??ß???e? t?? a????? µ???a t?? ??????a?
• ??e? µa?a?? ?f? (??µ?d?), ? ?p??a ?µ????e? µe t?
  a????????

3
S? ?? ???S??????

• ?et??e? st?? pa?a???? ?a? t?? eµp???t?sµ? t??
  sp??µat??
• ?etat??pe? t?? test?ste???? st?? e?e??? µ??f?
  t??, µe t? ß???e?a t?? ?at??????? e???µ?? p??
  pe????e?

4
??T?S??S ??? ???S????

• F??G???? (??e?a ? ?????a)
• ?????T?S ???????S?? ???S????
• ???????S ??? ???S????

5
????????S? ?O? F??G???O? ??? ???S????

• ????? ?????????? ???S????????
• ?????? ?????????? ???S????????
• ?????? ??????????? ???S???????? (S??????? ???????
  ???????? ?????)
• ?S????O?????? F??G???O??S ???S????????
  (?S????G??? ???S????????)

6
??S??? S????O???? ???S?????O? F??G???O?

• ?????S ??????S (S? ????? ??????????)
• ????S (S? ???S????/???????, ?S???-?????S, ???S,
  ??S??, ?SF? )
• S????????
• ??S????? S??? ????S? (??????? ?????? ????S?S ???
  ???S??T??? S ???? )
• ????S ???? ??? ????S? ? S?? ????S ??S
• ?????????? -????S??????

7
S????????? ??T?G???? ????G????S ???S????????S

• ESHERICHIA COLI
• KLEBSIELLA
• PROTEUS MIRABILIS
• ENTEROCOCCUS FAECALIS
• PSEUDOMONAS AERUGINOSA
• ??GO ??S ????S ??? ???S???? ?????? ??S???? ??
  ???????O ??????O??????

8
???G?OS? ??S ???S????????S

• ?S??????
• ??????? ?????? ??? ?ST????S (S????O??????G??)
• ????????? ?????S? ?? ?? ??T?
• ???????G??F??? ???S???? ()
• ???????G???S ???O?-???S??????? ?G??? ()

9
????S T???????S ???S????????S

• ????????? ??????OS? (????????S-?????T??????-??????
  ??????S-?????????S)
• ?-???S?????S (??? ??????? ??S?????? S??? ????S?)
• ????G?S ?????? ?O?S (??? ???S? ??????O?-???????S??
  S ????????O?-??????-??T??????O?-T????
  ??????????-??? S???? ?????-S???? ??S???????S?)

10
?????T?S ???????S?? ???S???? (?.?.?.)
11
?? ????? ? ?.?.?.

• ????????? G?? ??? ?S????G??? ???G?OS? ??S
  ??????????S ?O??S ??? ???S????, ? ????? ?F??? ???
  ??? ??G??????? ???? ???.
• ?????? ??????? ?? 80 ?O? ????O? ??????SS??? ???,
  ??OS ??? ???? ?? S????O??????G??..

12
?????T?S ???????S?? ???S????

• ? ?a?????? ?pe?p?as?a p??st?t? ( ??? ), e??a? µ?a
  p???s? ste?? s?et???µe?? µe t?? ?????a.
• ?? ?a? e??a? as???e?a, ? ?p??a de? ape??e? t?
  ???, ?st?s? ?? ???????? t?? e?d???se??
  (s?µpt?µat?????a ?at?te??? ????p???t????-LUTS ),
  ep??e????? s?µa?t??? t?? p???t?ta ????.
• ??????t??? LUTS, s?µßa????? se p??? ap? 30 t??
  a?d???, ??? t?? 65 et??.

13
?????OS? ??S ??? (??S??? S??????S????)

• ?p?a s?µpt?µata d?s?e???? ????s?? e??a? p???
  s???? se ??d?e? ?????a? ap? 50 et?? ?a? ???.
• ??t??a ?a? s?ßa?? LUTS, µp????? ?a ep??e?s???
  s?µa?t??? t?? p???t?ta ???? ?a? t?? ?a??µe?????
  d?ast????t?te? t?? at?µ??.
• ? s??s? µeta?? s?µpt?µ?t??, p??stat???? µe??????
  ?a? ???? ?????, e??a? s?et??? ?aµ???.

14
?????OS? ??S ??? ?? ??? ??????
15
F?S??? ?S????? ??S ???T?O???S ????????S ???

• 3 ??S???S T?O???S

16
T?O???S ????????S ???

• ? d?ata?a?? st??µat?? ep??????? st?? p??st?t?
• ?p?d?as? t?? p???d??aµ?? ??tt???? (stem cells)
  sta p??stat??? ??tta?a
• ?p?d?as? t?? ??st??????? (a???s? t?? ??st???????
  st?? ??d?a µe t?? p???d? t?? ?????a?)

17
????G????S ???????? ????????S ??S ???

• ?a???te?a e??e s?s?et?ste? µe pa??se?? ?p?? ?
  a?t???a?? ?p??tas?, ? ? sa??a??d?? d?aß?t??.
• S?µe?a, ?? µ???? a???e?? pa?????te? p??
  s?et????ta? µe t?? a??pt??? t?? ??s?? e??a?
• ? ?????a ?a? t? ??µ????? status.
• ( ?a? ?? 2 a?t?? pa?????te?, d?st???? ??a t??
  ??a, ß??s???ta? p??a ap? ???e d??at?t?ta
  p???????).

18
????G????S ???????? G?? ???????G??? T???????

• ? ???d???? a?????? ?e?????????? ?e?ape?a? ??a
  ???, a????e? µe t?? ?????a ?a? t?? ßa??t?ta t??
  a?????? s?µpt?µ?t??.
• ?e???? 3 st??? 10 ??d?e? ?a ?e??????????? ??a t??
  p???s?.
• ? ???t????a ?a? ?? µetaß???? st? ??? t?? ?????,
  fa??eta? ?a e??a? ta s?µa?t???te?a p?????st???
  s?µpt?µata.

19
? ??? ??? ?????SS???? ?????!

• ?e??p?? 30-45 t?? as?e??? ß?????? sta?e??p???s?,
  ? ?a? ?p?st??f? t?? s?µpt?µ?t?? t???.

20
S????O???? ???
???T?S????
??S????
??S????? ?????OS? ??????S ???O? ????????????
????S? ??????S? ?????? ???S ??????????-S???GG?????
-???????? ??? ????????OS?
S???????? ????????? ?????????? ????S?
21
??????S??S ??S ??? S?? ???????????? S?S????

• ????as? ??st??-d???d?s? ??st??
• ?d??????t??a? ?a? ?d????f??s?
• ?ef???? a?ep???e?a
• ?????p?µata ??ste??
• ???????µ??e??
• ??ste?????t????? pa???d??µ?s?.

22
???G?OS? ??S ?.?.?. (??S??? ???G?OS???? ??G?????)

• ??????S? ???S?????O? ?????????O?
• ????????? ?????S? ????? ??T?
• ?????S? PSA ??? ??????????S ????
• ????????S? ????????????? ?? ???????G??F??? ?
  ?????G??F??
• ?????G?S??S ???????????S ???O? ???? ??? ????S?

23

• ?????s? t????µat?? ??st??.
• ?e????? µ?s?? p??stat???? ??ß??.
• ( ??ste???af??? f?s? IVU-??????af?a?).

24

• ??atetaµ??? ??st?, ???? ???, µe d?µ??????a
  µe????? e?d???st???? ?????.

25

• ??atetaµ??? a??te?? ????p???t???, se as?e?? µe
  ???, ?a? a??pt??? µe????? µ?s?? p??stat????
  ??ß??, µe e?d???st??? p??ß???.

26
T??????? ??S ???

• ?????????T?S?
• F??????????? T???????
• ???SS??? ???????G??? T???????
• ?????S?? ?????????? T??????? (?INIMAL INVASIVE
  THERAPY)

27
?????????T?S? ??S ??? (watchful waiting)

• EN??????S
• ?????? SCORE S????O???O? (I-PSS)
• ????? S?????? ????????? ???O?
• ????????????? ??G?S?? ???????

28
F??????????? T???????
29
F??????????? T??????? ( ????????S)

• ??e? ??de??? ?e???? se a???st??? µe µ?s? score
  ???µa?a? s?µpt?µ?t?? ( I-PSS ), ????? ?a ?p??????
  ?? ap???te? e?de??e?? t?? ?e??????e???.

30
F??????????? T??????? ?F???S??????

• ???a? a?ast???a? t?? 5a-a?a????s?? ( 5a-RI)
• ??att??e? t?? p??stat??? ???? s??????????ta? t?
  p??stat??? ep??????
• ?e?t???e? ta s?µpt?µata ?a? t?? ??? t?? ?????
• ????st? ?e?ape?t??? ap?t??esµa pe??p?? st??? 6
  µ??e? ap? t?? ??a??? t?? ?e?ape?a?.
• ?? µe?a??te?? ?fe??? se p??st?te? gt 40 ml
• M?sa se 4-6 µ??e? ???s?? ?p?d?p?as???e? t? PSA
  ????.

31
F??????????? T??????? ??(a ad?e?e??????
a?ast??e??-a blockers)

• E?att????? t? d??aµ??? st???e?? t?? p??stat????
  ap?f?a???, a?ta??????µe??? t??? ad?e?e???????
  ?p?d??e??, p?? e??a? ?pe?????? ??a t?? t??? t??
  ?e??? µ????? ???? t?? p??st?t? ?a? t?? ??st????
  a????a.

32
F??????????? T?????? ???a-blockers

• ?et??a????? ??????? a?a???f?s? t?? s?µpt?µ?t??
  ?at? 20-50 ?a? µ?a ße?t??s? st?? ??????? ?at?
  20-30.
• ???e? a?ep???µ?te? e????e?e? ( p?????fa???, ????,
  ???. ?p?tas?, ?????? s?µf???s?, ?p????a,
  pa???d??µ? e?spe?µ?t?s?)
• ?a? de? ?p???e? ße?t??s? t?? s?µpt?µ?t?? µet? ap?
  8 eßd?µ?de? ?e?ape?a??d?a??p?.
• ?e? ??e? ap?de???e? ?fe??? ap? t? s??d?asµ???
  ?e?ape?a a-a?ast????? ?a? f??aste??d??.

33
F???T???????
34
F???T??????? ?d?e??????st?? µ??a??sµ?? s?et????
ap?te?esµat???t?ta? t?? pa?a??t? ??s???

• SERENOA REPENS ( ?µe????????? ????? f?????e?)
• PYGEUM AFRICANUM (Af???a???? daµ?s???a)
• ECHINACEA PURPUREA (???f??? a?aß?s?t??e???)
• HYPOXIS ROOPERI (G?as?d? ?. ?f?????)

35
???????G??? T???????
36
????????S ???????G???S T???????S

• ?p?s?es? ?????
• ?p?t??p?????se? ???????µ??e??
• ?p?t??p?????ta epe?s?de?a a?µat????a?
• ?p??easµ?? ?ef????? ?e?t?????a? (??? ?ef????
  a?ep???e?a)
• ????as? ????d???? ??st??
• ?????p?µata ????d???? ??st??.

37
???SS??? ???????G??? T???????

• ?????S???? ( ??????? ) ???S?????????
• ??????T???? ???S????????? ( TURP )
• ??????T???? ??????? ??? ???S????
• ( ?UIP )

38
?????S???? ???S?????????

• ????????S
• Se µe?????? ad??e?, ??? t?? 60 cc.
• Se ep?p?e?µ??? ???, µe µe?????? ??st????? ??????
  ? µe???? ??st??? e????p?µa.

39
??????T???? ?????? ??? ???S???? ( TURP )

• EN??????S
• Se µ?t??a d?????µ????? p??st?te? (??? 60cc)
• ??? ? ?e?????????? ?????? de? p???e?ta? ?a
  ?pe?ße? ta 60 ?ept?.

40
??????T???? ??????? ??? ???S???? ( ?UIP )

• EN??????S
• ?????? ad??a? ( ??t? t?? 20 cc )
• ????? µe???? µ?s? ??ß?
• ?e ?aµ??? ???d??? s???p?????t?? ?a??????
  (f?s???????? ??? ?a? PSA ???? ).

41
?????S?? ?????????? T???????( MINIMAL INVASIVE
THERAPY)

• Laser therapy ( TULIP )
• ???????????? ??e?t???a?t???asµ?? t?? p??st?t?
• ?pe??e?µ?a ( TUMT )
• ??????????? e?t?µ? t?? p??st?t? d?a ße?????
  (TUNA )
• ?????? ??tas?? est?asµ???? ?p??????(HIFU)
• ??d?????????? stents
• ??????????? d??tas? t?? p??st?t? µe µpa????

42
????????S MINIMAL INVASIVE THERAPY

• ?????? µe?????? p??st?te?
• ???? a?t?p??t???? a?????
• ?? ?pa??? µe????? µe?????? p??stat???? µ?s??
  ??ß??
• ?p????µ?a as?e???? ??a ??ass??? ?e?????????
  ?e?ape?a

43
???????S ??? ???S????
44
??????????G??? S???????

• ? ??s?? e????eta? ??a t? 9 t?? ?a??t?? ap?
  ?a?????, st??? ??d?e?
• ?a?????te? ???d???? ap?te???? ? ?????a, ?
  ?ata????s? ?????? ??p??, ?????a ???es? se ßa??a
  µ?ta??a ??p
• ? µ?t??s? t?? e?d???? p??stat???? a?t?????? (PSA)
  st? a?µa, ??e? ß????se? s?µa?t??? st? d?????s?
  t?? p??stat???? ?a?????? se p???µ?te?a st?d?a

45
S????O???? ??? ???S??????? ????????

• S??S ????S ??S ? ???????S ??? ???S???? ?????
  S????? ????? ?S????O??????S
• ???? S? ????????S ?????????????S, ???????
  S??????, ????? ??????? ?? ????????
• ????S??????? ????? ??? ?? ?S??, ???S ????????S ?
  ??? ?G??F???
• ???F???? ??S ????T??S ?? ?? ??????S?? ?? S?????
  ?????????? ? ???S??S?

46
???G?OS? ??? ???????? ??? ???S????

• ??????? ?????S? (????????? ????? ??T?)
• ?????S? PSA ????
• ???????OS? ??????S ??S?? ???? ??SO ?????T???????S
  ????T???S ??????S
• ??????? ????G??F?? ??O-???O ??????S ???
  S???T???G??F??? ?S?O? (G?? S?????????S? ??? ?G???)

47
T??????????S ?????G?S

• ?????????T?S?
• ?????? ???S?????????
• ??????T??????? ??O??????? ??????
• ?????T???????
• ??????T???????
• ??????T???????
• S?????S????S T???????S

48
?????G? ??S T???????S

• ?????? ?? ????? ??????????????
• T? ?????? ?? ?????????? S????? ?????? ? F?S???
  ????S??S? ??? ?ST????S ??? ?? ???S?O????
  ?????OS?S ???
• ? S?????S??S T???????S ?? S???? ??? ??S?, G??????
  ???? ? ???????S ????? ??????S????S ??S? S???
  ???S????
• ?? GOLD STANDARD THS T???????S ??? ???????
  ??????S????? ???????? ??? ???S???? ????????? ?
  ?????? ???????G??? ??? ?F????S?

49
????G????S ??????????????S S??? ??????? ???
???S????
???e ??d?a? ???d??e?e? ap? ?a????? t?? p??st?t?.
??a???se?? de ?????ta? ??a t??? d??s?µ??? ?a?
p???s???? ??t?ste ap?? t??? Ge???s?ast?? John
Kerry ?a? Bob Dole t?? p???? d?µa??? t?? ??a?
?????? Rudolph Giuliani, t? d?e????t? t?? Yankees
Joe Torre,t? d?e????t? t?? FBI Rober Mueller,t?
st?at??? Norman Schwartzkopf,t? ????? t??
????f Arnold Palmer,t??? ??t??af???a???? Nelson
Mandela ?a? Desmond Tutu,?p?? ?? Harry
Belafonte, Mery Griffin, Ed Asner, Sidney Poitier
?a? Jerry Lewis. ???sß???e? a???t?? ?a? ????st??,
p???t????? ?a? ?at????, d?as?µ?t?te? ?a?
?a??µe?????? a????p???. St?? p?a?µat???t?ta, ?
pe??pt?s? t?? ??d?a p?? de? ??e? ??p??? f??? ?
s???e?? p?? ?a p?s?e? ap? t?? as???e?a e??a?
sp???a. S???????, ? ?a?????? t?? p??st?t? ?a
d?a???s?e? se 221.000 ?µe???a???? f?t??, ?e?????
p?? t?? ?a??st? t?? p?? s???? es?te???? ?a????e?a
st??? ??d?e?.
50
???? ?? ??d?e? µp??e? ?a p??sß?????? ap? ?a?????
t?? p??st?t? a??? ??p???? d?at?????? ?????te??
???d??? ap? ??????. ??? ??p???? pa?????te?
ep????d???t?ta? s?et????ta? µe t?? pe?????, ?????
µp????? ?a t??p?p??????? p???e?µ???? ?a
ße?t?????? ?? p??a??t?te? t?? a?d???. Se p???
ep?ped? ß??s?este ?s?? af??? st?? ???d??? ?a? p??
µp??e?te ?a µe??sete t?? p??a??t?te? ?a
e?d???sete a?t?? t?? e?????t??? s????
as???e?a ???????e? µ?a s???e?t??t??? a?af??? t??
pa?a???t?? p?? s?µß?????? st?? ???d??? p??
d?at???ete ??a ?a????? t?? p??st?t?.
51
?????a ? ?????a e??a? ? s?µa?t???te???
pa?????ta? p??ß?e??? t?? ???d????. ? ?a?????? t??
p??st?t? e??a? sp????? se ??d?e? µ????te???? ap?
40 et?? ?a? a??et? as?????? se ??d?e? 40-50 et??.
???? ap? t?? ?????a t?? 50 et?? ?µ??, ?
p??a??t?ta e?d???s?? t?? ??s?? a????e? ?a?
s??e???e? ?a a????e? ??a ??? t? d????e?a t??
????. ? ep?pt?s? t?? ?a?????? t?? p??st?t?, st??
p?a?µat???t?ta, a????e? ???????te?a µe t?? ?????a
se s??s? µe ???e? s?µa?t???? ?a????e?e?. ????? ?
???d???? ??a ???e ?d?a?te?? ?????a?? ?µ?da ??
µe??te? ????? ap?d?se? a?t??????µe?a
ap?te??sµata, a??? ?se? s?µf????? ?t? ?s? ??
??d?e? µe?a??????, ? ???d???? p?? a?t?µet?p?????
???eta? e?p???t??? ??????(ß?.p??a?a). ???a? ??p??
t??µa?t??? t? ?e????? ?t? a? ??se? ?a?e?? a??et?,
?a e?d???se? ?a????? t?? p??st?t?. ?a ??µ?ste
?µ??, ?t? ?? pe??ss?te?e? pe??pt?se?? ?a??????
t?? p??st?t? se a?t?? t?? µe??te? e??a? as?µa?te?
ap? ???????? ?p????- ??p??a ?a????? ??tta?a ta
?p??a a?a?a??pt??ta? st? d????e?a p??????
a?t???a? se ??d?e? p?? p??a?a? ap? ???a a?t?a.
S???????, ? ???d???? p?? d?at???e? ??a?
?µe???a??? ?a e?d???se? st? d????e?a t?? ???? t??
p???µ? µ????s??p??? ?a????? t?? p??st?t? e??a?
s?ed?? 30 a??? ? ???d???? ??????? ap?dede??µ????
?a?????? t?? p??st?t? e??a? µ??? 9 ?a? ?
???d???? ?a pe???e? ap? t? ??s? e??a? s?ed?? 3.
52
?????e?e?a?? ?st????? ?? ep?d?µ??????? µa?
e??µe?????? ?t? ? ???d???? a??pt???? µ?a?
s???e???µ???? ??s?? e??a? s?et????. ?p?st???????
ep?s?? ?t?, ?s?? af??? st?? ?a????? t?? p??st?t?,
? ?pa??? s???e??? p?? p?s???? ap? t? ??s? a????e?
t?? ???d??? t?? a?d??? ?a ??s?se?. ??a? ??d?a?
t?? ?p???? ? pat??a? ? ? ade?f?? ??e? d?a???s?e?
??????? ?t? p?s?e? ap? ?a????? t?? p??st?t? ??e?
µ??µ?s? µe t?e?? f???? pe??ss?te?e? p??a??t?te?
?a e?d???se? t?? as???e?a se s??s? µe t??? ??d?e?
t?? ?p???? ?? ???????e?e? de? ????? ??s?se?. ??
p?s???te? ?e??? ?a? ??de?f?? ????? p??? µ????te??
ep?d?as? s??s? µe t??? pat??e? ?a? t??? ade?f???.
??a p??? ?s???? ?µ?? ?????e?e?a?? ?st?????
a????e? t?? ???d??? a??µa pe??ss?te??. ??a?
??d?a? p?? ??e? p?????? ste???? s???e?e?? µe
?a????? t?? p??st?t?- e?d??? a? ? d?????s? ??e?
???e? p??? ta 55- ??e? p??te f???? pe??ss?te?e?
p??a??t?te? ?a e?d???se? t? ??s? ?a? ? ?d???. ?
?a?????? t?? p??st?t? ??t?? p???a?e?ta? ap?
??p??? µ? f?s???????? ????d?? p?? pe??? ap? ?e???
se ?e??? ? e??a? t? ap?t??esµa ???es?? se
pe??ßa????t????? pa?????te? ?a? s????e?e? s?et???
µe t?? ??e?a, ?p?? ? d?at??f? ?a? ? ?s??s?,
pa?????te? p?? s???? e??a? ?????? st??
???????e?e?
53
?ta? ?? ep?st?µ??e? st? S?a?d??aß?a µe??t?sa?
44.788 ?e?????a d?d?µ??, ?at????a? st? s?µp??asµa
?t? t? 42 t?? ???d???? p?? d?at???e? ??a? ??d?a?
??a ?a????? t?? p??st?t? ?a µp????se ?a
e?µ??e??e? ap? ???????µ????? pa?????te? ?a? t?
?p????p? 58 ap? pe??ßa????t???? ep?d??se??. ?? ?
??e??a e??a? s?st?, ? ???????µ???t?ta ??e?
µe?a??te?? ep?d?as? st?? ?a????? t?? p??st?t? se
s??s? µe ???e? s????? ?a????e?e?
s?µpe???aµßa??µ???? t?? ??????????? ?a??????
(35) ?a? t?? ?a?????? t?? µast??(27). ??
ep?st?µ??e? de? ????? p??sd????se? ??e? t??
?e?et???? a??µa??e? p?? e??????ta? ??a ?a?????
t?? p??st?t? a??? s?µe?????? p???d?. ?????
st??µ?? ????????? ?t? d?? ????d?a fa??eta? ?t?
a??????? t?? ???d???. ?? p??t? a???e? st?
???µ?s?µa 1 ?a? ???µ??eta? HPC1. ?? de?te?? HPC2
ß??s?eta? st? ???µ?s?µa 17. ?ed?µ???? ?µ?? ?t?
?a? ta d?? a?t? ????d?a µa?? e??a? ?pa?t?a ??a
????te?e? ap? t? 10 t?? pe??pt?se?? ?a?????? t??
p??st?t?, p??pe? ?a ?p?????? ?a? ???a ????d?a p??
?a s?µß?????? st? ??s?. ?? p??a??? pe??pt?se??
pe???aµß????? ta MSRI, RNASAEL, t? ????d??
a?d????????? ?p?d???a ?a? t? ELAC2. ??p????
p???a?e? ?s?? t? ?e????? ?t? ?? ??d?e? p?? e??a?
s???e?e?? µe ???a??e? p?? p?s???? ap? ?a????? t??
µast?? ????? a???µ??? ???d??? e?d???s?? ?a??????
t?? p??st?t?, e?d??? a? f????? e?d????
µeta????e?? t?? ????d??? ??a t?? ?a????? t??
p??st?t? BRCA2.
54
(???p?p???µ??? ap? Report of the U.S Preventive
Services Task Force Guide to Clinical Preventive
Services, 2? ??d?s?, Williams and Wilkins,
1996,s.121).
55
??????t?ta. ? ep?pt?s? t?? ?a?????? t?? p??st?t?
p??????e? e?p???t??? a?? t?? ??sµ?. ???µa ?a?
af?? s???p?????st??? d?????t??? ? ?????a ?a? ?
????t?ta t?? d?????s??, e??a? 120 f????
s????te??? st? Sa? F?a?s?s?? se s??s? µe t??
epa???a?? ???a ?a? p??? ap? 4 f???? s????te??
st?? ???µ??e? ????te?e? se s??s? µe t?? ?ap???a.
?µ?µa t?? d?af???? µp??e? ?a ??e? ?e?et??? ß?s?,
?p?? t? ?????e?e?a?? ?st?????. ?fe??eta? ?µ?? ?a?
se pa?????te? s?et????? µe t? pe??ß????? ?a? t??
t??p? ????. G?a pa??de??µa, ?? ??p??e? p??
µeta??µ????? st?? ?a??f????a ap??t??? µe?a??te??
???d??? ??a ?a????? t?? p??st?t? ?a? ? ???d????
a????eta? ??a t?? ep?µe?? ?e??? p?? ?e????ta?
st?? ?µe????. S?µf??a µe t? Health Professionals
Follow-up Study t?? Harvard ?? ?µe???a???
?s?at???? ?ata????? d?at?????? t?? ?d?? ???d???
??a ?a????? t?? p??st?t? µe t??? ?e?????
?µe???a????.
56
F???. ? ?a?????? t?? p??st?t? e??a? s????te???
st??? ?????µ??? a??µa ?a? af?? ?p?????st??? ?
?????a, ?? ???????????????µ???? pa?????te? ?a? ?
p??sßas? st?? ?at???? f???t?da ?a? t?? e?et?se??.
?? pe??ss?te?e? µe??te? e?t?µ?sa? p?? ??
?f??aµe???a??? d?at?????? 30 ?????te?? ???d???
se s??s? µe t??? ?a???s????. ? ?e?et??? ß?ßa?a
µp??e? ?a e????eta? ??a ???sµ??e? ap? a?t?? t??
d?af????, a??? ?a? ? t??p?? ???? ?a? ?d?a?te?a ?
d?at??f? pa????? ep?s?? ????. ??t?? e??a? ? ?????
p?? ?? ?f??aµe???a??? ????? s?µa?t??? ?????te??
ep?p??asµ? ?a?????? t?? p??st?t? se s??s? µe t???
?????µ??? ??d?e? st?? ?f???? ? t?? ?s?a.
57
??µ??e?. ?? a?d????? f??et???? ??µ??e?
(a?d?????a), ?p?? ? test?ste???? ?a? ?
d??d??test?ste???? p??????? t?? a??pt???
p??stat???? ??tt???? e?te p???e?ta? ??a ?a?????
e?te ??a ?a?????. ? ?a?????? t?? p??st?t? st??
?????p? pe??????eta? µe t? ???? ?e?ape?a?
st???s?? a?d???????. ?a???? ?µ?? p?? ta a?d?????a
pa????? s?????a µe???? ???? st?? ?a????? t??
p??st?t? s???? ??d?e? p?? p?s???? ap? t? ??s? de?
pa???s?????? as?????sta ????? ep?peda ??µ????. ??
??µa t?? ??µ???? e??a? s???et? ?a? p??pe? ?a
µe?et??e? pe?a?t???. ???? t? pa??? de? e??a?
d??at?? ?a ?a????ste? ? ???d???? p?? d?at??????
?? ??d?e? µe t? µ?t??s? t?? ??µ??????
ep?p?d??. ?? ?a? ta a?d?????a ????? t? µe?a??te??
ep?d?as? st?? p??st?t?, ?p?????? ?? ???e? ??µ??e?
p?? µp??e? ?a e??a? s?µa?t????. G?a pa??de??µa,
?? ep?st?µ??e? t?? Harvard ????? s??d?se? ta
????? ep?peda t?? ??s??????e?d??? a???t????
pa?????ta (IGF-1) µe a???µ??? ???d??? ??a
?a?????. ?a? µ?a µe??t? t?? 2003 a?af??e? ?t?
??d?e? µe a?t?stas? st?? ??s?????? d?at??????
a???µ??? ???d??? ??a ?a????? t?? p??st?t?, a??µa
?a? af?? ??ß??µe ?p????? t?? ?????a?? pa??sa???a
(ß?. t?? p????f???e? ??a t? d?at??f? st?
s????e?a). ?? ep?ßeßa???e? a?t? ? ??a pa?at???s?,
?? ??d?e? ?a e??a???????? ?a ße?t??s??? t??
a?tap????s? st?? ??s?????? µe ta?t??? ?s??s?,
??e??? t?? ß????? ?a? ???e??? d?at??f?.
58
??at??f?. ???a? ? s?µa?t???te??? pa?????ta?
ep????d???t?ta? p?? µp??e? ?a e?e???e?. ?
?????te??? ?????? e??a? ta ???esµ??a ????? ??p?
?p?? t? ???a? ?a? ta ?a?a?t???µ??? p?????ta µe
p???? ??pa??. ???e? t??f?? ?µ?? fa??eta? ?a
µe?????? t?? ???d??? ?? ?t?µ?te? ?a? ???a
?a?a????, ? s???a, ta d?µ?t??a?? ?????? ??es??,
?? ????? ?a?p?? ?a? ?? sp???? ?a??? ?a? ta ????a
e??a? ??a st? ??sta t?? ?a??? t??f??. ??? ?
t??f? fa??eta? ?a ap?te?e? t?? ?a??te?? p???
d???t??? p??state?t???? ??ept???? s?stat????,
s?µp????µata se?????? ?a? p??a??? ????p????
µp??e? ep?s?? ?a ß??????. ?? ?a? ?p?????? e?p?de?
?t? ? ße?t??s? t?? d?at??f?? µe???e? t?? ???d???
??a ?a????? t?? p??st?t? de? ?p?????? a??µa
d?a??s?µe? ap?de??e??. Ost?s?, µ?a
p??state?t??? ??a t?? p??st?t? d?at??f? ?a
µe??se? t?? p??a??t?te? ?a?d?a??? ??s??, ??????
a?t???a??? p?es??, d?aß?t? ?a? pa??sa???a?. ?a
??µ?ste ?t? ?ta? p???e?ta? ??a t?? ??e?a, e?ste
?,t? t??te.
59
?s??s?. ? d?at??f? ?a? ? ?s??s? ap?te???? ta
?eµ???a ??a µ?a ???e??? ???. G?a t?? ?a????? t??
p??st?t? ?µ??, ? d?at??f? e??a? p??? p??
s?µa?t???. St? µe??t? Harvard Alumni Study
d?ap?st????e ?t? ?? ??d?e? p?? d???e???? µe
a??et? ??tas? ?ste ?a ?a??e 4.000 ?e?µ?de? t??
eßd?µ?da d?at?????? µe??µ??? ???d??? ??a ?a?????
t?? p??st?t?- a??? ??e?????ta? 40 µ???a
t?e??µat?? ? pa??µ??a? ?s??s?? ??a ?a ep?te???e?
? st????. ??a ?e?te?? ??e??a ap? t? ???ß???a, t?
F???a?d?a ?a? t?? ??? a?af??e? ?t? ? µ?t??a
?s??s?, ?p?? t? pe?p?t?µa, s?et??eta? µe µe??µ???
???d???, a??? ???e? µe??te? de? a?af????? ?t?
?p???e? ??p??a s?s??t?s?. ???a? apa?a?t?t? ?a
?????? pe??ss?te?e? ??e??e?, a??? µ?
st??????????este µ???? ?a pe??µ??ete ta
ap?te??sµata. ? ta?t??? ?s??s? ?a µe??se? t??
???d??? ??a p????? ap? t?? ?????e? ??s??? p??
µast????? t?? ?µe???? t?? 21?? a???a.
60
????? s?µat??. ?p??e? ? ?atas?e?? e??? a????p??
?a p??ß???e? t?? ???d??? ?a ??s?se? ? pa??sa???a
saf?? a????e? t?? ???d??? e?d???s?? ?a?d?a???
??s?? ?a??? ?a? p????? ?a????e???. ??a s?µa?t???
µe??t? t?? 2003 s???dese t?? pa??sa???a µe t??
?a????? t?? p??st?t?. ?s? pa??te??? e??a? ?
??d?a? t?s? µe?a??te?? ???d??? d?at???e?. G?a
t??? pa??te????, a?t? s??ep??eta? a???s? t??
???d???? ?at? 34. ??a µe??t? t?? 1997 se 135.000
S???d??? ?de??e ?t? ?? e?s?µ?? ??d?e? ??s???
pe??ss?te?? ap? ?a????? t?? p??st?t? e?te t?
µ??e??? a?af??eta? st? ???? e?te st? ß???? e?te
st? de??t? µ??a? t?? s?µat?? (? ?p????
a?t??at?pt???e? t?? pa??sa???a). Se d?? µe??te?
t?? Harvard d?ap?st????e ?t? t? ???? a????e? t??
???d??? a??? µ?a p??sfat? ???es? ap? t?? ???a,
?p?? ? ?a?????? t?? p??st?t? ß??s?eta? se ???d?
?a??? ?? d?t???? s????e?e? sa?????? t? ???a
a?af??e? µ??? ?????a?? pa??sa???a. ?? e?p?s??µe
?t? ta ???????a st???e?a e??a? s?st? ??at? ??a
t?? pe??µet?? t?? µ?s?? µp??e? ?a?e?? ?a ???e?
??t?.
61
??p??sµa. ? ?ap??? p???a?e? t?s? p?????
?a????e?e? p?? e??a? ?????? ?a e??a? ?p?pt?? ?a?
??a t?? ?a????? t?? p??st?t?. ?a st???e?a ?µ??
e??a? a??µ??ta se p????? µe??te? de
d?ap?st??eta? s?s??t?s?, e?? se ???e? a?af??eta?
p?? t? ßa?? ??p??sµa µp??e? ?a a???se? t??
???d??? e??? ??d?a ?a pe???e? ap? ?a????? t??
p??st?t? ??? 45. ???a? ??a s???t?s?µ? s?µe??
ded?µ???? ?t? ?a?e?? ??d?a? (? ?aµ?a ???a??a) de
?a ?p?epe ?a ?ap???e?.
62
?ata????s? p?t??. ?? a????? ??e? a??µ??te?
ep?d??se?? st?? ??e?a se µ????? p?s?t?te? e??a?
???e???, se µe?a??te?e? ß?aße??. ?? ?a? se
µe????? µe??te? a?af??eta? ?t? ? µe????
?ata????s? p?t?? a????e? t?? ???d??? t?? a????p??
??a ?a????? t?? p??st?t?, µ?a µet?-a????s? t??
2000 33 d?µ?s?e?se?? ??e??a? de d?ap?st?sa?
??p??a ep?d?as?. S???????, ?? a??s???e? ??a t??
?a????? t?? p??st?t? de ?a p??pe? ?a ep??e?????
t?? ap?fas? ??p???? s?et??? µe t? p?t?.  
63
Se???a???? d?ast????t?ta. ? p??st?t?? e??a?
a?apa?a?????? ???a??. ? µ??ad??? t?? ?e?t?????a
e??a? ?a s??e?sf??e? ???? st? sp??µa. ?pe?d?
s??d?eta? t?s? ?µesa µe t? s??, ?? ?at???
a?a??t????a? a? ? se???a???? d?ast????t?ta ?a? ta
se???a????? µetad?d?µe?a ??s?µata µp??e? ?a
a??????? t?? ???d??? ??a ?a????? t?? p??st?t?.
????? p??sfata ? ap??t?s? ?ta? ???. ???? s?µf??a
µe µ?a µe??t? t?? 2001 st?? ????te?a t??
???s???t?? ? ?pa??? p????? se???a????? s??t??f??
s??de?ta? µe a???µ??? ???d??? ??a ?a????? t??
p??st?t?. ? ???d???? e??a? µe?a??te??? se ??d?e?
µe t????ta ? pe??ss?te?e? s??t??f??? st? d????e?a
t?? ???? t??? a??? ?a? ? µ????? a???µ??
s??t??f??, d?? µe t?sse???, fa??eta? ?a a????e?
t?? ???d???. ????e?ta? ?µ?? ??a µ??? µ?a µe??t?
?a? p??pe? a??µa ?a ep?ßeßa???e?.
64
??? a??s??e?te ? ?a?????? t?? p??st?t? e??a? t?s?
s????? a???ß?? epe?d? ?p?????? t?s?? pa?????te?
ep????d???t?ta?. ?eta?? ???? a?t?? t?? a??s?????,
e??a? ?a?? ?a ??????e? ?a?e?? ?t? ??p????
d???t???? ?????? ????? a????e?. ? ßas???te???
e??a? ? e?t?µ? t?? spe?µat???? p????. ?? ?a? ??
d?? µe??te? t?? 1993( ap? t? Harvard) a???sa? t??
a??s???e? ?t? a?t? ? ap?? ep?µßas? ?e?et????
e?????? µp??e? ?a a????e? t?? ???d???, p?????
???? st???e??? de ß??s???? st???e?a s?s??t?s??
t?? e?t?µ?? t?? spe?µat???? p???? µe epa???????
?a????? t?? p??st?t?. ?s?? af??? se ?t?d?p?te
???? ? ?a?????? t?? p??st?t? e??a? d?µ???at????
? ???????????????µ??? ?at?stas? de? ??e? ep?d?as?
st?? ???d??? ( a? ?a? ? e???p?? p??sßas? st?
f???t?da t?? ??e?a? eµp?d??e? t? d?????s? ?a? t?
?e?ape?a). ?????, ??te ? ?a?????? p??stat???
?pe?p?as?a ??te ? p??stat?t?da (f?e?µ??? t??
ad??a) s??d???ta? µe t?? ?a????? t?? p??st?t?.
?a?e?? de? e??a? ?a???µe??? µe a?t? ta p??ß??µata
a??? t??????st?? de ??e???eta? ?a a??s??e? ?a?
??a µe?a??te?? ???d??? e?d???s?? ?a??????.
65
????pt????   ?? s?µa????? ?? pa?????te?
ep????d???t?ta? ??a ?a????? ??a es?? ???t??
e??a? s?µa?t??? ?a ??????ete a? d?at???ete
???d??? µe?a??te?? ap? t? µ?s? ???. ?? a?t?
?s??e?, ?s?? ?a e??a? ?????? ?a ep????ete ?a
a???????sete µ?a ep??et??? p??s????s? ??a t??
a????e?s? ?a? t? d?????s?. ? ?a??te??? t??p?? t??
?at??? ?a a????e?s??? t?? ?a????? t?? p??st?t?
st? p?? p???µ? ?a? ?e?ape?s?µ? st?d?? e??a? ?a
d?e?????? µ?a e??tas? a?µat?? ??a e?d???
p??stat??? a?t????? ? µ?a e??tas? PSA. ?? ?a?
e??a? ????te?? ap?te?esµat???, ? da?t?????
e??tas? ap? t? ???? µp??e? ep?s?? ?a ß????se?. ?
e??tas? ??a ?a????? t?? p??st?t? se p???µ? st?d??
e??a? aµf??e??µe?? epe?d? ?? e?et?se?? e??a?
a?a???ße??, epe?d? de? ap?de????eta? ?t? ?
a????e?s? s??e? ????, ?a? epe?d? ? a????e?s?
µp??e? ?a ?d???se? se ?e?ape?e? µe p???
s?µa?t???? pa?e????e?e?. ?? ?at??? ?a p??pe? ?a
pa???s?????? ta p?e??e?t?µata ?a? ta
µe???e?t?µata se ???e as?e?? ???e ????? µe ?????a
??a???? ta 50 ?t?. ???? ?? ??d?e? µe a???µ???
???d??? ?a p??pe? ?a µe?et??? t?? pe??pt?s?
e??tas?? se µ????te?? ?????a. ?? et?s?e?
ap?f?se?? ??a t?? e?et?se?? PSA ?a? da?t?????
e??tas? ?e?????? st?? ?????a t?? 40 et??. ?
American Cancer Society a???se p??sfata t?
s?stas? t?? ap? ta 40 sta 45.
66
? ???a??? p?????s? ß???? a??? ? p?????? e??a?
a??µa ?a??te??. ?a?e?? de? µp??e? ?a a????e? t???
s???e?e?? t?? ? ?a a?????se? ta ????d?? t??, p?s?
µ????? ?a staµat?se? t? d?ad??as?a t?? ???a?s??.
?p??e? ?µ?? ?a?e?? ?a ???e? s?µa?t???? a??a??? se
???a ped?a. ??a ?a?? d?at??f? ??? µ??? ?fe?e? t??
p??st?t? a??? p??state?e? ?a? ap? ?a?d?a?? ??s?,
?p??tas?, d?aß?t? ?a? pa??sa???a. ??a? ?????
p??st?t?? te???? ??e???eta? ?a? ??a ????? s?µa
???? t??.
67
S?S ??????S?O..