前列腺疾病与男性健康

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允祭沈
5 years ago
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1 Know your Prostate Dr. Martin Wong 泌尿專科黄國田醫生

2 What is Prostate? Urethra Bladder Prostate At the outlet of the urinary bladder. Part of the internal sex gland to produce the substance sperms need for fertilization.

3 Benign Prostatic hyperplasia The size of a normal prostate is like a walnut With advancement of age, the size of our prostate may increase to be like a plum.

6 Ben Stiller

8 What are the common categories of Prostate Diseases Prostatitis BPH Prostate cancer

9 Signs & symptoms of prostate diseases Nocturia Urinary frequency Urgency Poor urine flow Intermittency Need straining to void Incomplete urine emptying

10 Lower urinary tract symptoms (LUTS) Irritative symptoms Nocturia Urinary frequency Urgency Obstructive symptoms Poor flow Intermittency Straining Incomplete emptying

11 Complications Frequent infection Haematuria Bladder stones Impaired kidney function

12 Incidence Incidence 85% 10% 35 歲 85 歲 Age Incidence of BPH increases with age

13 Normal prostate

14 Early BPH

15 Moderate BPH

16 Advanced BPH

17 How to diagnose BPH Self assessment International Prostate Symptoms Score(IPSS) Voiding diary One-minute test

18 How to diagnose BPH Specialist s assessment Digital rectal examination(dre) Transrectal ultrasound (TRUS) Uroflowmetry Urodynamic study X ray (KUB) Cystoscopy

19 Digital rectal examination (DRE)

20 Transrectal Ultrasound(TRUS)

21 尿流速測試 Uroflowmetry

22 泌尿動力學檢查 Urodynamic study

23 X ray (KUB)

24 膀胱內窺鏡檢查 Cystoscopy

25 Treatment options Active surveillance Drug treatment Surgical operation

26 Active surveillance Suitable for patients with early BPH Regular checkup PSA uroflowmetry

27 Drug treatment Suitable for moderate BPH Two kinds of commonly used drugs 5 -reductase inhibitors -control the size blockers -improve flow rate

28 5 -Reductase inhibitor Slow down prostate enlargement Reduce bleeding episodes Slow onset of action Affect PSA monitoring

29 blockers Rapid onset of action Will not affect PSA monitoring Effective in reducing urinary symptoms First line treatment of BPH

30 Surgical operation Failed drug treatment For severe cases with complications

31 Severe BPH symptoms IPSS higher than 20 Uroflow less than 10 ml/sec

32 Complications Acute retention Bladder stones Infection Haematuria Renal impairment

33 Minimally invasive surgery Transurethral surgery Diathermy/laser/microwave/radiofrequency Resection Vapourisation Coagulation

34 TURP 經尿道前列腺切除手術

35 Plasma vapourization 電漿氣化手術

36 Laser vapourisation 激光氣化手術

37 Interstitial Laser coagulation (ILC)

38 Transurethral Microwave Therapy (TUMT)

39 Transurethral Needle Ablation (TUNA)

40 汽球擴張術 Balloon dilation

41 前列腺支架 (Prostatic stenting)

42 經尿道前列腺氣化切除術 Transurethral Resection & Vaporisation of Prostate (TURVP)

43 Open/laparoscopic surgery

44 Prostate Cancer

45 Trans-peritoneal Surgery

46 3 rd place in Cancer Incidence 資料來源 : 醫管局癌症資料統計中心

47 Cancer death rate 2012

50 Cause of Prostate Cancer Congenital inheritance Acquired Advanced age Carcinogens

51 How to diagnose Prostate Cancer

52 Early Prostate Cancer May have no symptom at all May be very similar to BPH

53 Detection of Prostate Cancer Basic investigation: History/physicalexam Digital rectal exam (DRE) (PSA)

54 Prostate Specific Antigen (PSA) Less than 4 g/l Cancer risk: Higher than 4 g/l Cancer 30% Prostate

55 Histo-pathology

56 First question in cancer patients mind Any spread? Early or late stage?

57 核磁共振攝影 (MRI) 或電腦斷層掃瞄 (CT) Quality images Locate tumour Assess local invasion

58 放射性同位素骨掃描 Radioisotope bone scan Very sensitive To detect bony metastasis

59 正電子及電腦雙融掃描 ( 雙示踪劑 ) Positron Emission Tomogram PET/CT (Dual tracers)

60 膀胱鏡 (Cystoscopy)

61 前列腺癌的分期局限於前列腺內, 通常無症狀,DRE 不能發現 T1 局限於前列腺內, 無症狀,DRE 能夠發現 T2 排尿困難和尿痛等, 擴散入前列腺周圍 T3 淋巴結和遠處轉移 T4

62 Treating Prostate Cancer Three important points to consider: Age Past health Cancer staging

63 治療 Treatment Active surveillance 積極觀察 Radical surgery 根治性手術 Radiotherapy 放射治療 Hormonal therapy 激素治療 Chemotherapy 化療 Multi-disciplinary Management of Prostate Cancer 前列腺癌多元綜合治療

64 Tumour staging Early stage Chance of radical treatment Surgery or Radiotherapy Late stage Control tumour progression & Palliation Hormonal treatment or Chemotherapy

65 Radical prostatectomy Open surgery Robotic-assisted 達文西機械手臂

66 Laparoscopic surgery

67 Da Vinci System 達文西手術系統

68 Da Vinci System 達文西手術系統

69 放射治療 Radiation Therapy

70 荷爾蒙治療 Hormonal Therapy

71 第二線荷爾蒙葯物 Second line Hormonal Therapy

72 Combination with chemotherapy Large tumour load Metastatic disease Late stage disease

73 舒緩治療 Palliative Treatment

74 重要訊息及早診斷, 至為重要 40 歲後吸煙人士有前列腺病徵有家族病史約見泌尿外科醫生接受肛門指檢定期驗血 (PSA) 如有懷疑及早接受前列腺活檢

75 醫生的話預防勝於治療, 要 : 認識前列腺疾病定期檢查及早求醫

85 謝謝!

Microsoft PowerPoint - 21

Microsoft PowerPoint - 21 男士健康與常見問題 2 0 0 5 年 3 月 DR. PETER C. HO 何震傑醫生泌尿外科美國紐約大學 Doctor of Medicine 美國泌尿科醫學委員會文憑加拿大皇家外科醫學院院士 1. 心臟病 2. 高血壓 3. 糖尿病 4. 良性前列腺增生 5. 性無能與男