前列腺癌英文版精品医学课件.ppt
Carcinoma of prostate,Epidemiology(流行病学）,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,2015年美国预测发病人数220,800人,Globoscan statistics,2012,CA Cancer J Clin 2015;00:00-00,etiology（病因学）,The cause of prostate cancer is still unknown genetic,hormonal,dietary,environmental influences.(遗传、内分泌、饮食、环境因素）positive family history,pathology,98%are adenocarcinoma（腺癌）Others are transitional-cell carcinoma（移行细胞癌）squamous-cell carcinoma（鳞状细胞癌）undifferentiated carcinoma（未分化癌）,pathology,60-70%peripheral zone10-20%transition zone5%-10%central zoneGleason score:2-4 well differentiation 5-7 moderate differentiation 8-10 poor differentiation,more maligant,metastasis,hematogenous metastasis:vertebral column,pelvis lymphatic metastasis direct invasion,Symptoms and signs,No symptoms:early stagebladder outlet obstruction 60%Previously:50%with the signs of metastasesNow:fewer than 20%,because of earlier diagnosis,terminal symptoms,Anemia 贫血Asthenia 衰弱edema of lower extremity 下肢浮肿Difficult defecation 排便困难Osteodynia 骨痛Fracture 骨折Spinal compression 脊柱压迫,staging,Can not feel by the finger,How to diagnose the PC?,Laboratory findings,Prostate-specific antigen(前列腺特异性抗原，PSA）is elevated in 60%patientsPSA above 4ng/mL is abnormalMethods for enhancing PSA:参考正常值 age-specific PSA 0.75ng/(mly)PSA density 0.15 percent-free PSA 16%Total PSA is useful for staging,but not absolute,DRE,rectal touch,DRE,rectal touch,Imaging examination,Transrectal ultrasound(经直肠超声检查TRUS):typical hypoechoic peripheral zone lesions 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,Transrectal ultrasound(经直肠超声检查),MRI,CT scan,Biopsy and grading,Ultrasound guided prostate biopsyGraded by the Gleason scoreGleason score:more high more aggressive,treatment,Watchful waiting(严密观察）Surgery（手术治疗）Endocrine therapy（内分泌治疗）radiotherapy（放疗）chemotherapy（化疗）,Watchful waiting,In the operation of benign prostatic hyperplasia and find incidental carcinoma stage Gleason score:low,operation,Radical prostatectomy（根治性前列腺切除术）:early stage patient:stage and open operation laproscopic operation indications：expected life longer than 10 years,indications,laproscopic,laproscopic radical prostatectomy,glandula seminalis,urethra,glandula seminalis,radiotherapy,internal radiation therapy（放射性核素粒子（如I125）植入内照射）：stage external radiation therapy(外照射）local control new opinion:radical radiotherapy,internal radiation,external radiation,2008 world Richest man 2012 diagnosed PC external radiation therapyHealthy now,Endocrine therapy,Stage and stage,male castration（睾丸切除）:not androgen deprivation male castration（睾丸切除）+Androgen preparation（抗雄激素制剂）analog of leuteinizing hormone releasing(促黄体激素释放激素类似物，LHRH-A)+Androgen preparation estrogen(second line)others（雌激素和其他）,chemotherapy,If the endocrine therapy is failure,chemotherapy may be helpful.New method.Cryotherapy,Irreversible electroporation new drug:Antiandrogen,Targeted therapeutic agents,
