Table 4.

Suggestions for the clinical management of PC patients.

Follow-up of radically resected patients • After definitive treatment of the local disease, a patient follow-up should be implemented, including physical examination, blood calcium and parathyroid hormone levels, and periodic radiological imaging assessments. • Periodic radiological evaluations during follow-up should include neck ultrasound, and CT scan of the abdomen and thorax. Brain CT and/or MR should be considered in case of suspicious neurological symptoms. • Follow-up should be prosecuted for at least 5 years. • Total body 99mTc-sestaMIBI and/or 18F-FDG PET/CT scans can be complementary to conventional imaging in the initial staging.

Treatment • Surgery of metastasis should be persecuted as first approach whenever possible. • If complete removal of all metastases is not possible, other local treatments could reasonably be considered. • Systemic therapies should be considered in patients not amenable to surgery and/or local regional therapies.

Systemic treatment • Transient control of hypercalcemia can be achieved with the use of bone resorption inhibitors, such as bisphosphonates and denosumab. • Calcimimetic drugs, such as cinacalcet, are recommended treatment. • Dacarbazine and anthracyclines containing schemes are the chemotherapy of choice in the management of metastatic PC. • Anti-angiogenetic drugs and immunotherapy could also be possible options.