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Management of Localized and Locally Advanced Disease
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=== Established Treatment Options for Localized Prostate Cancer === ==== <span style="color:#ff0000">Options (4):</span> ==== # '''<span style="color:#ff0000">Active surveillance (AS)/expectant management</span>''' # '''<span style="color:#ff0000">Thermal ablation (TA)</span>''' # '''<span style="color:#ff0000">Partial nephrectomy (PN)</span>''' # '''<span style="color:#ff0000">Radical nephrectomy (RN)</span>''' ==== Patient counseling ==== * Review the most common and serious urologic and non-urologic morbidities of each treatment pathway. * Discuss potential effect of intervention on risk of chronic kidney disease (CKD), dialysis, and survival. ** Patients with renal masses often have a high burden of CKD at baseline because of the shared risk factors with RCC and CKD, such as hypertension. ** '''Predictive factors for post-operative development of CKD or progression of pre-existing CKD (8):''' **# '''Older age''' **# '''Diabetes''' **# '''Hypertension''' **# '''Male sex''' **# '''Obesity''' **# '''Tobacco use''' **# '''Larger tumour size''' **# '''Post-operative acute kidney injury''' ** Optimizing glycemic and blood pressure control, smoking cessation and minimizing risk of acute kidney injury (with avoidance of hypotension and nephrotoxic agents such as intravenous contrast or non-steroidal anti-inflammatory drugs) should reduce the degree of renal dysfunction in the perioperative period.
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