1、Carcinoma of prostate第1頁，共31頁。Epidemiology(流行病學） The morbility is very high in the west country, it is the most high incidence of the males. more prevalent in black malesThe second disease which cause deathThe disease incidence is becoming higher and higher in China 第2頁，共31頁。2015年美國預測發病人數220,800人Glo

2、boscan statistics,2012, CA Cancer J Clin 2015;00:00-00第3頁，共31頁。etiology （病因學）The cause of prostate cancer is still unknown genetic, hormonal, dietary, environmental influences. (遺傳、內分泌、飲食、環境因素）positive family history第4頁，共31頁。pathology98% are adenocarcinoma （腺癌）Others are transitional-cell carcinoma

3、（移行細胞癌） squamous-cell carcinoma （鱗狀細胞癌） undifferentiated carcinoma （未分化癌）第5頁，共31頁。pathology60-70% peripheral zone10-20% transition zone5%-10% central zoneGleason score: 2-4 well differentiation 5-7 moderate differentiation 8-10 poor differentiation, more maligant第6頁，共31頁。metastasishematogenous metas

4、tasis :vertebral column, pelvis lymphatic metastasis direct invasion第7頁，共31頁。Symptoms and signs No symptoms : early stagebladder outlet obstruction 60%Previously: 50% with the signs of metastasesNow: fewer than 20%, because of earlier diagnosis 第8頁，共31頁。terminal symptomsAnemia 貧血Asthenia 衰弱edema of

5、lower extremity 下肢浮腫Difficult defecation 排便困難Osteodynia 骨痛Fracture 骨折Spinal compression 脊柱壓迫第9頁，共31頁。stagingCan not feel by the finger 第10頁，共31頁。How to diagnose the PC?第11頁，共31頁。Laboratory findingsProstate-specific antigen(前列腺特異性抗原，PSA） is elevated in 60% patientsPSA above 4ng/mL is abnormalMethods

6、for enhancing PSA: 參考正常值 age-specific PSA 0.75ng/(mly) PSA density 0.15 percent-free PSA 16% Total PSA is useful for staging, but not absolute第12頁，共31頁。DRErectal touch 第13頁，共31頁。DRErectal touch 第14頁，共31頁。Imaging examinationTransrectal ultrasound(經直腸超聲檢查TRUS): typical hypoechoic peripheral zone lesio

7、ns intravenous urogram（尿路造影） : urinary retention or ureter obstructionChest or abdominal x ray: metastases of boneCT: enlarge prostate and lymph nodesMRI: more helpful in staging of prostate cancer 第15頁，共31頁。Transrectal ultrasound(經直腸超聲檢查)第16頁，共31頁。MRI第17頁，共31頁。CT scan第18頁，共31頁。Biopsy and grading Ul

8、trasound guided prostate biopsyGraded by the Gleason scoreGleason score: more high more aggressive第19頁，共31頁。treatmentWatchful waiting (嚴密觀察）Surgery （手術治療）Endocrine therapy （內分泌治療）radiotherapy （放療）chemotherapy （化療）第20頁，共31頁。Watchful waiting In the operation of benign prostatic hyperplasia and find in

9、cidental carcinoma stage Gleason score: low第21頁，共31頁。operation Radical prostatectomy （根治性前列腺切除術） : early stage patient: stage and open operation laproscopic operation indications ： expected life longer than 10 yearsindications 第22頁，共31頁。laproscopic第23頁，共31頁。laproscopic radical prostatectomy 第24頁，共31

10、頁。glandula seminalisurethra glandula seminalis第25頁，共31頁。radiotherapyinternal radiation therapy （放射性核素粒子（如I125）植入內照射）：stage external radiation therapy (外照射） local control new opinion: radical radiotherapy第26頁，共31頁。internal radiation 第27頁，共31頁。external radiation 第28頁，共31頁。2008 world Richest man 2012 d

11、iagnosed PC external radiation therapyHealthy now第29頁，共31頁。Endocrine therapyStage and stage male castration（睪丸切除）: not androgen deprivation male castration（睪丸切除） + Androgen preparation（抗雄激素制劑）analog of leuteinizing hormone releasing(促黃體激素釋放激素類似物，LHRH-A) + Androgen preparation estrogen (second line)others（雌激素和其他）第30頁，共31頁。chemotherapy If the e