By Babjuk M., Oosterlinck W., Sylvester R.

The EAU instructions place of work has been overseeing the construction of guidance and scientific perform strategies for a few years now. on the outset of this venture it used to be said that the aim of those texts isn't really to be proscriptive within the manner a clinician should still deal with a sufferer, yet relatively to supply entry to the simplest contemporaneous consensus view at the ideal administration at the moment on hand. This nonetheless applies and the EAU directions usually are not intended to be legislations texts yet are produced with the final word target to aid urologists with their daily perform.

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To be counted, a pattern (grade) needs to occupy more than 5% of the biopsy specimen. Biopsy material (core biopsy or operative specimens) is required to be able to assess the Gleason score; cytological preparations cannot be used. Diagnosis and staging The decision to proceed with further diagnostic or staging work-up is guided by which treatment options are available to the patient, taking age and comorbidity into consideration. Procedures that will not affect the treatment decision can usually be avoided.

RCC comprises four genetically different subtypes: conventional (clear cell) (80–90%), papillary (10–15%), chromophobe RCC (4–5%), and collecting duct carcinoma (1%). In general, the RCC types have different clinical courses and responses to therapy. The Fuhrman grading and RCC subtype classification are recommended. Several integrated prognostic systems and nomograms, combining dependent prognostic factors, have been developed. These nomograms can be useful for predicting survival and differentiating follow-up.

In patients with symptomatic osseous metastases due to HRPCA, either docetaxel or mitoxantrone with prednisone or hydrocortisone are viable therapeutic options (grade A recommendation). Bisphosphonates may be offered to patients with skeletal metastases (mainly zoledronic acid has been studied) to prevent osseous complications (grade A recommendation). Palliative treatments such as radionuclids, external beam radiotherapy, and adequate use of analgesics should be considered early on in the management of painful osseous metastases (grade B recommendation).

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