前列腺癌（英文版）

CarcinomaofprostateEpidemiology(流行病学）

Themorbilityisveryhighinthewestcountry,itisthemosthighincidence

ofthemales.moreprevalentinblackmalesTheseconddiseasewhichcausedeathThediseaseincidence

isbecominghigherandhigherinChina2015年美国预测发病人数220,800人Globoscanstatistics,2012,CACancerJClin2015;00:00-00etiology（病因学）Thecauseofprostatecancerisstillunknowngenetic,hormonal,dietary,environmentalinfluences.(遗传、内分泌、饮食、环境因素）positivefamilyhistorypathology98%areadenocarcinoma（腺癌）Othersaretransitional-cellcarcinoma（移行细胞癌）

squamous-cellcarcinoma（鳞状细胞癌）

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贫血Asthenia衰弱edemaoflowerextremity下肢浮肿Difficultdefecation排便困难Osteodynia骨痛Fracture骨折Spinalcompression脊柱压迫stagingCannotfeelbythefinger

HowtodiagnosethePC?LaboratoryfindingsProstate-specificantigen(前列腺特异性抗原，PSA）iselevatedin60%patientsPSAabove4ng/mLisabnormalMethodsforenhancingPSA:参考正常值

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

percent-freePSA＞16%

TotalPSAisusefulforstaging,butnotabsoluteDRErectaltouchDRErectaltouchImagingexaminationTransrectalultrasound(经直肠超声检查TRUS):typicalhypoechoicperipheralzonelesionsintravenousurogram（尿路造影）:urinaryretentionorureterobstructionChestorabdominalxray:metastasesofboneCT:enlargeprostateandlymphnodesMRI:morehelpfulinstagingofprostatecancer

Transrectalultrasound(经直肠超声检查)MRICTscanBiopsyandgrading

UltrasoundguidedprostatebiopsyGradedbytheGleasonscoreGleasonscore:morehighmoreaggressivetreatmentWatchfulwaiting(严密观察）Surgery（手术治疗）Endocrinetherapy（内分泌治疗）radiotherapy（放疗）chemotherapy（化疗）WatchfulwaitingIntheoperationofbenignprostatichyperplasiaandfindincidentalcarcinomaⅠstageGleasonscore:lowoperation

Radicalprostatectomy

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

openoperation

laproscopicoperation

indications

：expectedlifelongerthan10yearsindicationslaproscopiclaproscopicradicalprostatectomy

glandulaseminalisurethraglandulaseminalisradiotherapyinternalradiationtherapy

（放射性核素粒子（如I125）植入内照射）：stageⅡexternalradiationtherapy(外照射）

localcontrolnewopinion:radicalradiotherapyinternalradiation

externalradiation

2008worldRichestman2012diagnosedPCexternalradiationtherapyHealthynowEndocrinetherapyStageⅢandstageⅣ

malecastration（睾丸切除）:notandrogendeprivation

malecastration（睾丸切除）+Androgenpreparation（抗雄激素制剂）analogofleuteinizinghormonereleasing(促黄体激素释放激素类似物，LHRH-A)+Androgenpreparation

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