TRATAMIENTO DEL CÁNCER DE PRÓSTATA METASTÁSICO HORMONOSENSIBLE (2023)

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RECOMENDACIONES

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VERSIÓN ARTÍCULO

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Ámbito
  • Esta guía debe ser usada en todos los establecimientos del seguro social del Perú (EsSalud), según lo correspondiente a su nivel de atención.
Población y alcance
  • Población: Población: Adultos (mayores de 18 años) con adenocarcinoma de próstata metastásico hormonosensible con presentación de novo o recurrente y de alto o bajo volumen metastásico.

  • Usuarios: Esta GPC está dirigida al personal médico y no médico, que participa en la atención multidisciplinaria del paciente con cáncer de próstata metastásico hormonosensible. Las recomendaciones serán aplicadas por oncólogos, urólogos, radioterapeutas y médicos residentes de dichas especialidades. Asimismo, podrá ser utilizada como referencia por médicos con otras especialidades afines al manejo de esta condición, estudiantes de profesiones relacionadas al ámbito de la salud, y pacientes.
Autores

Grupo elaborador
Expertos clínicos:

  • Cuevas Muñoz, Nelson.
    Médico oncólogo. Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
  • Broncano Huasasquiche, Oswaldo.
    Médico radioterapeuta. Hospital Nacional Alberto Sabogal Sologuren, EsSalud, Lima, Perú
  • Cuentas Jara, Mariano Jaime.
    Médico urólogo. Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
  • Livano Yberico, Teófilo.
    Médico oncólogo. Hospital Nacional Alberto Sabogal Sologuren, EsSalud, Lima, Perú
  • Codier Mariaca, Abel.
    Médico urólogo. Hospital Nacional Alberto Sabogal Sologuren, EsSalud, Lima, Perú
  • Velarde Ponce, Luis Alberto.
    Médico urólogo. Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
  • Delgado Iriarte, Jesús.
    Médico oncólogo. Hospital Daniel Alcides Carrion, EsSalud, Tacna, Perú

Metodólogos:

  • Goicochea Lugo, Sergio André.
    Metodólogo. IETSI, EsSalud, Lima, Perú
  • Delgado Flores, Carolina Jaqueline
    Metodóloga. IETSI, EsSalud, Lima, Perú

Gestores:

  • Salvador Salvador, Stefany.
    Coordinadora del grupo elaborador. IETSI, EsSalud, Lima, Perú
  • Carrera Acosta, Lourdes del Rocío.
    Coordinadora del grupo elaborador. IETSI, EsSalud, Lima, Perú


Metodología

Resumen de la metodología:

  • Conformación del GEG: La Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia, del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud), conformó un grupo elaborador de la guía (GEG), que incluyó médicos especialistas y metodólogos.
  • Planteamiento de preguntas clínicas: En concordancia con los objetivos y alcances de esta GPC, se formularon las preguntas clínicas.
  • Búsqueda de la evidencia para cada pregunta: Para cada pregunta clínica, se realizaron búsquedas de revisiones sistemáticas (publicadas como artículos científicos o guías de práctica clínica). De no encontrar revisiones de calidad, se buscaron estudios primarios, cuyo riesgo de sesgo fue evaluado usando herramientas estandarizadas.
  • Evaluación de la certeza de la evidencia: Para graduar la certeza de la evidencia, se siguió la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE), y se usaron tablas de Summary of Findings (SoF).
  • Formulación de las recomendaciones: El GEG revisó la evidencia recolectada para cada una de las preguntas clínicas en reuniones periódicas, en las que formuló las recomendaciones usando la metodología GRADE, otorgándole una fuerza a cada una. Para ello, se tuvo en consideración los beneficios y daños de las opciones, valores y preferencias de los pacientes, aceptabilidad, factibilidad, equidad y uso de recursos. Estos criterios fueron presentados y discutidos, tomando una decisión por consenso o mayoría simple. Asimismo, el GEG emitió puntos de buenas prácticas clínicas (BPC) sin una evaluación formal de la evidencia, y mayormente en base a su experiencia clínica.
  • Revisión externa: La presente GPC fue revisada en reuniones con profesionales representantes de otras instituciones, tomadores de decisiones, y expertos externos.
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    1. TDA con bloqueo androgénico completo vs TDA con monoterapia
    2. TDA temprana vs TDA diferida
    3. TDA farmacológica vs TDA quirúrgica
    4. TDA intermitente vs TDA continua
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