前列腺癌（英文版）

CarcinomaofprostateEpidemiology(流行病學(xué)）

Themorbilityisveryhighinthewestcountry,itisthemosthighincidence

ofthemales.moreprevalentinblackmalesTheseconddiseasewhichcausedeathThediseaseincidence

isbecominghigherandhigherinChina2015年美國預(yù)測發(fā)病人數(shù)220,800人Globoscanstatistics,2012,CACancerJClin2015;00:00-00etiology（病因?qū)W）Thecauseofprostatecancerisstillunknowngenetic,hormonal,dietary,environmentalinfluences.(遺傳、內(nèi)分泌、飲食、環(huán)境因素）positivefamilyhistorypathology98%areadenocarcinoma（腺癌）Othersaretransitional-cellcarcinoma（移行細(xì)胞癌）

squamous-cellcarcinoma（鱗狀細(xì)胞癌）

undifferentiatedcarcinoma（未分化癌）pathology60-70%peripheralzone10-20%transitionzone5%-10%centralzoneGleasonscore:2-4welldifferentiation5-7moderatedifferentiation8-10poordifferentiation,moremaligantmetastasishematogenousmetastasis:

vertebralcolumn,pelvislymphaticmetastasisdirectinvasionSymptomsandsigns

Nosymptoms:earlystagebladderoutletobstruction60%Previously:50%withthesignsofmetastasesNow:fewerthan20%,becauseofearlierdiagnosis

terminalsymptomsAnemia貧血Asthenia衰弱edemaoflowerextremity下肢浮腫Difficultdefecation排便困難Osteodynia骨痛Fracture骨折Spinalcompression脊柱壓迫stagingCannotfeelbythefinger

HowtodiagnosethePC?LaboratoryfindingsProstate-specificantigen(前列腺特異性抗原，PSA）iselevatedin60%patientsPSAabove4ng/mLisabnormalMethodsforenhancingPSA:參考正常值

age-specificPSA＜0.75ng/(ml·y)PSAdensity＜0.15

percent-freePSA＞16%

TotalPSAisusefulforstaging,butnotabsoluteDRErectaltouchDRErectaltouchImagingexaminationTransrectalultrasound(經(jīng)直腸超聲檢查TRUS):typicalhypoechoicperipheralzonelesionsintravenousurogram（尿路造影）:urinaryretentionorureterobstructionChestorabdominalxray:metastasesofboneCT:enlargeprostateandlymphnodesMRI:morehelpfulinstagingofprostatecancer

Transrectalultrasound(經(jīng)直腸超聲檢查)MRICTscanBiopsyandgrading

UltrasoundguidedprostatebiopsyGradedbytheGleasonscoreGleasonscore:morehighmoreaggressivetreatmentWatchfulwaiting(嚴(yán)密觀察）Surgery（手術(shù)治療）Endocrinetherapy（內(nèi)分泌治療）radiotherapy（放療）chemotherapy（化療）WatchfulwaitingIntheoperationofbenignprostatichyperplasiaandfindincidentalcarcinomaⅠstageGleasonscore:lowoperation

Radicalprostatectomy

（根治性前列腺切除術(shù)）:earlystagepatient:stageⅠandⅡ

openoperation

laproscopicoperation

indications

：expectedlifelongerthan10yearsindicationslaproscopiclaproscopicradicalprostatectomy

glandulaseminalisurethraglandulaseminalisradiotherapyinternalradiationtherapy

（放射性核素粒子（如I125）植入內(nèi)照射）：stageⅡexternalradiationtherapy(外照射）

localcontrolnewopinion:radicalradiotherapyinternalradiation

externalradiation

2008worldRichestman2012diagnosedPCexternalradiationtherapyHealthynowEndocrinetherapyStageⅢandstageⅣ

malecastration（睪丸切除）:notandrogendeprivation

malecastration（睪丸切除）+Androgenpreparation（抗雄激素制劑）analogofleuteinizinghormonereleasing(促黃體激素釋放激素類似物，LHRH-A)+Androgenpreparation

estrogen(secondline)others（雌激素和其他）chemotherapy