前列腺癌英文版医学教学课件

1、Carcinoma of prostate第1页，共31页。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 第2页，共31页。2015年美国预测发病人数220,800人Glo

2、boscan statistics,2012, CA Cancer J Clin 2015;00:00-00第3页，共31页。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第4页，共31页。pathology98% are adenocarcinoma （腺癌）Others are transitional-cell carcinoma

3、（移行细胞癌） squamous-cell carcinoma （鳞状细胞癌） undifferentiated carcinoma （未分化癌）第5页，共31页。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页，共31页。metastasishematogenous metas

4、tasis :vertebral column, pelvis lymphatic metastasis direct invasion第7页，共31页。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页，共31页。terminal symptomsAnemia 贫血Asthenia 衰弱edema of

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

6、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第12页，共31页。DRErectal touch 第13页，共31页。DRErectal touch 第14页，共31页。Imaging examinationTransrectal ultrasound(经直肠超声检查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页，共31页。Transrectal ultrasound(经直肠超声检查)第16页，共31页。MRI第17页，共31页。CT scan第18页，共31页。Biopsy and grading Ul

8、trasound guided prostate biopsyGraded by the Gleason scoreGleason score: more high more aggressive第19页，共31页。treatmentWatchful waiting (严密观察）Surgery （手术治疗）Endocrine therapy （内分泌治疗）radiotherapy （放疗）chemotherapy （化疗）第20页，共31页。Watchful waiting In the operation of benign prostatic hyperplasia and find in

9、cidental carcinoma stage Gleason score: low第21页，共31页。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 yearsindications 第22页，共31页。laproscopic第23页，共31页。laproscopic radical prostatectomy 第24页，共31

10、页。glandula seminalisurethra glandula seminalis第25页，共31页。radiotherapyinternal 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第26页，共31页。internal radiation 第27页，共31页。external radiation 第28页，共31页。2008 world Richest man 2012 d

11、iagnosed PC external radiation therapyHealthy now第29页，共31页。Endocrine therapyStage 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）第30页，共31页。chemotherapy If the e