AUA前列腺癌介紹課件

1、2010年美國泌尿外科年會(huì)前列腺癌相關(guān)進(jìn)展北京大學(xué)第三醫(yī)院泌尿外科劉磊 馬潞林關(guān)于前列腺癌的文獻(xiàn)數(shù)量多，分類細(xì)臨床隨訪數(shù)量多，資料翔實(shí)涉及的領(lǐng)域比較廣泛問題1前列腺癌根治術(shù)（RP）、前列腺癌外放射治療（EBRT）、前列腺癌近距離照射治療（brachytherapy）這三種方法治療效果的比較？問題1EBRT and brachytherapy were significantly associated with diminished survival (HR 1.6 95% CI: 1.4-1.9 and 1.7 95% CI: 1.4-2.1, respectively; P 0.001)co

2、mpared to radical prostatectomy after adjusting for biopsy Gleason score, PSA, age, comorbidity, ethnicity, and clinical stage. 問題1EBRT and brachytherapy were also associated with a significantly higher rate of androgen-deprivation therapy (P 2 +LN. The EI, O and H regions had positive nodes in 37%,

3、 60% and 49% of patients (figure).問題2 Venous thrombo-embolism (VTE) is a source of serious morbidity and mortality after radical prostatectomy (RP). Pelvic lymph node dissection (PLND), traditionally a routine part of RP, may be related to the development of VTE.1951 PELVIC LYMPH NODE DISSECTION IS

4、ASSOCIATED WITH VENOUS THROMBOEMBOLISM RISK DURING LAPAROSCOPIC RADICAL PROSTATECTOMY問題2The records of 773 consecutive patients who underwent laparoscopic radical prostatectomy (LRP) by a single surgeon from 2001-2009 were reviewed for postoperative VTE.469 patients (60.7%) underwent LRP+PLND; 304 u

5、nderwent LRP only (39.3%). VTE occurred in 7/469 LRP+PLND patients (1.5%), and in 0/304 LRP-only patients (0%) (p=0.046). Surgical approach (extra- or trans-peritoneal) and cancer stage were not risk factors for VTE. Only 4/469 (0.9%) men had positive lymph nodes.問題2PLND during LRP may increase the

6、risk of VTE without providing an obvious cancer control benefit in most patients with clinically localized prostate cancer. Our data argue that PLND should be judiciously rather than routinely performed on patients at extremely low risk for LN metastasis.問題2Despite the lower incidence of +LN in our

7、series, the distribution of +LN was identical to Studers. The O and H were the only sites of +LN in 31% and 26% of our patients, so a PLND limited to the EI area, above the obturator nerve, would miss more than half of contemporary RP patients with +LN. Whenever PLND is indicated during RP, a full P

8、LND should be performed.問題3前列腺癌根治術(shù)后切緣陰性的患者腫瘤復(fù)發(fā)的幾率有多大，危險(xiǎn)因素有哪些？問題3A Total of 8078 patients were identified with negative surgical margins at the time of RP. Median age and BMI at the time of RP were 63 years and 27.5, respectively. Median preoperative PSA was 5.9. Of these patients, a confirmed local

9、recurrence was noted in 335/8078 (4.1%). On multivariable analysis increased Gleason score noted on preoperative biopsy (p = 0.0053) and tumor volume (p = 0.0003) were significantly associated with local recurrence despite negative surgical margins.問題4彈性超聲成像對(duì)前列腺癌檢測(cè)的結(jié)果如何？問題4Between August 2008 and Ju

10、ly 2009 229 patients with biopsy proven PCa underwent preoperative SE with the latest sonoelastographic device (Hitachi, EUB-7500HV).問題4The prostate was divided into 6 areas (base,mid, apex for each side, n=1374) and subsequently screened for cancer suspicious areas. This was postulated for hypoecho

11、ic lesions during GSU and stiffer blue-colored lesions according to SE,respectively.問題4In comparison with transrectal grayscale ultrasound, sonoelastography of the prostate provides a significant improvement on visualizing prostate cancer. Locating prostate cancer and evaluating extracapsular extens

12、ion is more precise using latest generation of sonoelastography.問題5高危前列腺癌術(shù)后的效果如何？問題5Controversy exists regarding the optimal treatment for patients with clinical high risk prostate cancer (PCa).Recent retrospective series have shown good cancer control when patients are treated with surgery as part

13、of a multimodality approach, especially when specimen confined at pathological assessment. 2030 HIGH-RISK PROSTATE CANCER PATIENTS WHO HAVE SPECIMEN-CONFINED DISEASE AT PATHOLOGY HAVE EXCEPTIONALLY GOOD OUTCOMES AFTER SURGERY.問題5Cancer-specific survival（CSS）significantly better in patients with spec

14、imen confined disease compared to those without (10-year CSS 97.4% vs 82.5%, p0.0001). Patients with specimen confined disease were also dramatically less likely to receive adjuvant RT (5.8 vs. 31.4%, p0.0001) and HT (16.2 vs. 64.1%, p0.0001). Outcome of patients withHigh risk prostate cancer is not

15、 invariably poor.問題6吸煙與前列腺癌的復(fù)發(fā)率是否有關(guān)系？Among patients undergoing radical prostatectomy in SEARCH, cigarette smoking was associated with slightly more advanced disease but similar risk for biochemical recurrence（289）.問題7前列腺癌根治術(shù)后10年，如果沒有生化復(fù)發(fā)，我們是否可以停止PSA的檢測(cè)？The majority of biochemical recurrence occurs w

16、ithin 10 years of surgery. Patients who remain free from progression at 10 years postoperatively should be counseled that their risk of subsequent cancerrelated morbidity and mortality is low（290）.問題8前列腺癌近距離照射治療對(duì)性功能的影響？After prostate brachytherapy,81.3% and 90% of sexually active men conserved ejacu

17、lation and orgasm, respectively.Most of the population treated by brachytherapy conserves ejaculation after prostate brachytherapy. However, a majority describe reduction of volume and deterioration of orgasm （460）. 問題9前列腺癌根治術(shù)后服用他汀類藥物是否可以減低生化復(fù)發(fā)率？Initiating statin therapy after RP was associated with a 39% reduction in the risk for PSA recurrence among men who underwent RP（292）.問題10前列腺癌根治術(shù)后切緣陽性部位的Gleason分級(jí)是否會(huì)影響