Know your Prostate Dr. Martin Wong 泌尿專科黄國田醫生
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.
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.
Ben Stiller
What are the common categories of Prostate Diseases Prostatitis BPH Prostate cancer
Signs & symptoms of prostate diseases Nocturia Urinary frequency Urgency Poor urine flow Intermittency Need straining to void Incomplete urine emptying
Lower urinary tract symptoms (LUTS) Irritative symptoms Nocturia Urinary frequency Urgency Obstructive symptoms Poor flow Intermittency Straining Incomplete emptying
Complications Frequent infection Haematuria Bladder stones Impaired kidney function
Incidence Incidence 85% 10% 35 歲 85 歲 Age Incidence of BPH increases with age
Normal prostate
Early BPH
Moderate BPH
Advanced BPH
How to diagnose BPH Self assessment International Prostate Symptoms Score(IPSS) Voiding diary One-minute test
How to diagnose BPH Specialist s assessment Digital rectal examination(dre) Transrectal ultrasound (TRUS) Uroflowmetry Urodynamic study X ray (KUB) Cystoscopy
Digital rectal examination (DRE)
Transrectal Ultrasound(TRUS)
尿流速測試 Uroflowmetry
泌尿動力學檢查 Urodynamic study
X ray (KUB)
膀胱內窺鏡檢查 Cystoscopy
Treatment options Active surveillance Drug treatment Surgical operation
Active surveillance Suitable for patients with early BPH Regular checkup PSA uroflowmetry
Drug treatment Suitable for moderate BPH Two kinds of commonly used drugs 5 -reductase inhibitors -control the size blockers -improve flow rate
5 -Reductase inhibitor Slow down prostate enlargement Reduce bleeding episodes Slow onset of action Affect PSA monitoring
blockers Rapid onset of action Will not affect PSA monitoring Effective in reducing urinary symptoms First line treatment of BPH
Surgical operation Failed drug treatment For severe cases with complications
Severe BPH symptoms IPSS higher than 20 Uroflow less than 10 ml/sec
Complications Acute retention Bladder stones Infection Haematuria Renal impairment
Minimally invasive surgery Transurethral surgery Diathermy/laser/microwave/radiofrequency Resection Vapourisation Coagulation
TURP 經尿道前列腺切除手術
Plasma vapourization 電漿氣化手術
Laser vapourisation 激光氣化手術
Interstitial Laser coagulation (ILC)
Transurethral Microwave Therapy (TUMT)
Transurethral Needle Ablation (TUNA)
汽球擴張術 Balloon dilation
前列腺支架 (Prostatic stenting)
經尿道前列腺氣化切除術 Transurethral Resection & Vaporisation of Prostate (TURVP)
Open/laparoscopic surgery
Prostate Cancer
Trans-peritoneal Surgery
3 rd place in Cancer Incidence 資料來源 : 醫管局癌症資料統計中心
Cancer death rate 2012
Cause of Prostate Cancer Congenital inheritance Acquired Advanced age Carcinogens
How to diagnose Prostate Cancer
Early Prostate Cancer May have no symptom at all May be very similar to BPH
Detection of Prostate Cancer Basic investigation: History/physicalexam Digital rectal exam (DRE) (PSA)
Prostate Specific Antigen (PSA) Less than 4 g/l Cancer risk: Higher than 4 g/l Cancer 30% Prostate
Histo-pathology
First question in cancer patients mind Any spread? Early or late stage?
核磁共振攝影 (MRI) 或電腦斷層掃瞄 (CT) Quality images Locate tumour Assess local invasion
放射性同位素骨掃描 Radioisotope bone scan Very sensitive To detect bony metastasis
正電子及電腦雙融掃描 ( 雙示踪劑 ) Positron Emission Tomogram PET/CT (Dual tracers)
膀胱鏡 (Cystoscopy)
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
Treating Prostate Cancer Three important points to consider: Age Past health Cancer staging
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
Tumour staging Early stage Chance of radical treatment Surgery or Radiotherapy Late stage Control tumour progression & Palliation Hormonal treatment or Chemotherapy
Radical prostatectomy Open surgery Robotic-assisted 達文西機械手臂
Laparoscopic surgery
Da Vinci System 達文西手術系統
Da Vinci System 達文西手術系統
放射治療 Radiation Therapy
荷爾蒙治療 Hormonal Therapy
第二線荷爾蒙葯物 Second line Hormonal Therapy
Combination with chemotherapy Large tumour load Metastatic disease Late stage disease
舒緩治療 Palliative Treatment
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
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
謝謝!