ៗသᕝ ޠ ଝ ਫ ᚃᏱτᏱ ݫ ऌ 娵倸䔊䕂䊼㭿 ဝᕜਲ਼ҏџоϚҢ ݽ ᕛȄ ۻڗ ᢎ ᄇᗙ Ϛᄇ? Ճኌ ޟ ӰશԤ ӵѯᢊȃ ဝᕜ ޟ ҡ ԑ ٥? ٲ բᓍ এដᚠ ޟ ဝ੫ ቨёȂਲ਼ᐃ ҕ ஶဍҕ 103 ԑ ޟ ת ন (PSA) ᑢᔮ ޟ ցᇄᄒ : ר ঈ ޣ ᕜ Ȃ ဝᕜϐԙ Ρ ၾ PSA Ԟ ᘞ ဝᕜ ޟ ցᏢȃ σᕜ ޟ Ϥ ȂӓԤ 4904 छ Ӓ७ ဝ੫ ת ন (PSA) এਰȇ ဝᕜϐԙ σᕜ ԫӰ ᑢ ᔮ ӻ ԑȃ ณ ӵ 2012 ԑ छ ޟ US ޟ ϲ ; ܒظ ᕜ ԫιনӰ ޟ Μ Preventive Services Task Force (USPSTF) Ȅ ဝᕜϐԙ ܒظ ஶ ޟ १ ᐠᄺ ߒ : Ϛ ដ PSA ᔮก ; ដᚠ! Ӱ ؠ Ԥш ᜌᐃᡗҰ PSA ᑢᔮџ о६ճ ဝᕜ ޟ ԫι, и ဝ ハỏ䗝䕂ᵄ墡 娵倸䔊" ᕜ ݽ ᕛџ բᓍԥϛ ޟي ᒸ!? ר ঈάᔖԃդ? پ Ԥ ޟ ٲ ᔮᡛ ᗶณ ဝᕜ ޟ ᘞᇄ ݽ ᕛӵߖ П ݲ ȃҡ ސ ȃኇ Ᏸ ޟ ᔮᡛџо ԑ پ Ԥ ߝ ޟ ȂณՄȂ ר ঈ ᔓօ ר ঈդਢሯ ဝϸа? ۻڗ ઍ ޟ ϐငο ဝᕜ? ॶ ޱ კၐᄇ ٲ ဝᕜல ޟ ដᚠȂ ӑ : ۻڗ ဝᕜሯϚሯ ᑖ ݽ ᕛ? ΙМᝦϷ ݙ ᇄ ଆȄ ӵ 20 ԑࠉ ᚂৱ ޟ ਢঐ, ல᠙ ڗ Ԥ ࠉٲ ᎆᚂৱȃ ـ Ᏸ ܖޱ ඪ ڗ : 娵倸䔊㓭 斾堿䤋㠳㭹䔀" ဝᕜ ඔ ܒ ᕜȂ ᄚȂϚҢ ᑖ ݽ ᕛȂζԤ ٲ ᚂৱᇄ Ȃ ဝᕜ ඔ ܒ ᕜ ޟ ౩
榖斂恩 㗁奊 -2851$/ 2).$2+6,81* 0(',&$/ $662&,$7,21 92/ 12 ٷ ᐃк پ Ռࡏᡝ ড ޟ : ԤМ ϐင ٨ Ϸ 4 ܖ 5, ౩ϐင ᝦ ю : ӵ 50 оΰ ܒظޟ, Ӱ ڏ т ဝѓጰѴሯ ᑖ ݽ ᕛ ޟ নӰԫι, ডਢԤ 21% џ ౪Ԥ ဝᕜ! ဝᕜ ; এШ ٽ ᓍ ԑឭཕଽմቨ ёȃrullis I Ᏸ ޱ ӵ 80 оΰ ҥ ବᄇᖝ ח Ϛᡗ ޟ ܒ ظ ޟ 67% џ ౪ Ԥ ဝ ᕜȄ ဝ ᕜȂ џ ӑ ڥ к ଢ଼ ᅿ Ȟactive фߒ ቄཎဎ? ڹ ٲ ဝᕜȂ surveillanceȟȅо ଡᙹ PSA, ߞه ತ ڏ ΙҡζϚ അԙএਰ ޑ ޟ ᇄ, ຜ ݷ ՃኌӔ င ޢ ဗ ҡ ࡄڼ : ܚ ᒝ ޟ ȶᖝ ח Ϛ१ ޟ ဝϸаȂоຟե ϫᎌӫ ଡᙹ ဝ ᕜ ȷ FOLQLFDO LQVLJQL FDQW SURVWDWH ᢎᄆȂԃ ౪ရዴඌ ܒ ቨёȂࠌᙽ cancer)ȅ ٲ ဝ ᕜ Ԥ ӓ ӣ ޟ ᑖ ݽܒ ᕛȄ ੫ ; ܒ ᡝᑖ ω ( ӻኵᏰ ޱ Ң кଢ଼ᅿ ޟ ᓺᘈ џоᗗջ ܖ <0.5 ҳ П ϴ Ϸ Ϸ ) и Ϸ Ͻ ي ԁ : ጥ ڧ ᑖ ݽܒ ᕛ ځޟ Ȃծ ٨ Ϸ ኵ (Gleason Score) ӵ 6 Ϸ о ᘈ ϫԥᕜ ᇄᙽಋ ॳޟ ᓎȂи ήȃࠁ३ӵ ဝϱȄᏰ౩ΰ پ ᇳȇ এਰџ ฐኌȂሯІ ଡᙹᇄ ԃ װݎ ٲ Ϛ१ ޟ ဝᕜ ᘞю ϸаᔮࢥȅਲ਼ᐃσ ޟـ ๖ ݎ ᡗҰ : پ Ȃ ٽ ԃ ցң PSA ᑢᔮ - ᆎ ٷٺ ᐃ ޟ నӇȂ ڧ кᢎᅿก ᘞȇᄇ ٲ ౩ ΰϚҢ ݽ ᕛ ޟ ޟ ဝᕜএਰϫԤ 20~35% ҡ ဝᕜ ݽ ᕛ ; ᆎ ȶ ݽ Ȃ8%~ 44% ҡ ٨ Ϸኵቨ ᕛȷȂІՄџ അԙϚ ځޟ Ȅ ёȃ Ԥ 24%~33% ശ ತ ᗙ ݽ ڧ ᕛ ณՄȂ ᚠ پ Οɯ ԃդⴑกএਰ ( ყΙᇄߒΙ )Ȅ ϸа ᘞ ޟ ဝᕜ ᖝ ח Ϛ१ ޟ ဝᕜ? Epstein ඪюΙ : 娵倸䄷䐮ㅕ 36$ 䪧㥠䕂 僅ⷈ ᖝ ח տ T1C, PSA < 0.15 ng/ ml, ؠ Ԥ ٨ Ϸ 4 ܖ 5 ޟ ရዴȂω ۻ ڗ ኄ ݿ ᄇ ҕ PSA ᑢ ᔮ 3 এϸаԤᕜಠफᇄ এϸаᔮᡝ ցσ ᄒ? ڹ এᢎ ഋϷџо (core) ᕜಠफ < 50%ȄณՄȂ ޟ ԃყπ ܚ Ұ : ר ঈ ה ఖ PSA ᑢᔮ ޟڗ ـ ᡗҰ Epstein ޟ ғጂⴑก Ԥ ဝᕜ ᖝ ח १ - ሯ ᑖ ݽ ᕛ घ 70% -- һ घ 30% নҏ௰ก ᖝ ח ޟ ဝᕜ : ԃყπϛ ყ ܚ Ұ, ծ Ϛᡗ ޟ ဝᕜ, ӵ ౪ ڏ ᄂ ጂᄂԤΙഋϷ ޟ ဝᕜ Ϸ
ڗ १Ȃ ҡሉ ฮϗ ᘞю پ Ȃ ӵ Ѯᢊ౪Ϭ ޟ ݷ ϚᆗЍ ኵȂ ਲ਼ ᐃ П ಛ ၥ ਟ, Ρ ဝᕜߑ ᘞϐငԤሉ ᙽಋ ( ᖝ ח Ѳ ) ޟ Ш घћ έԙέ (33%), ᇄछ ᘞюሉ ᙽಋ ԤԻ Ϸ Ϟ Ѳ (4%) Ԥ σ ޟ ৯ຽ! Ӕ Ι Ճ ; 䖡 弧 傦ⵈ 札匕䕂 娵倸䔊濕㿴今濕㗇䯂 䕂ỉ㜆 侻Ⲱ 䱑㓭傦ⵈ札匕 娵倸䔊濕斾堿䤋㠳㭹䔀Ʋ ᘞਢ ޟ ᖝ ח տᇄԇ Ԥᡗ ᜰȄ ٷ ᐃ Ѯσᚂ ᇎҗ ௲ ޟ Ѯᢊ ဝᕜᖝ ח ၥਟ ޟ ၥਟᡗҰ ( ყέ ): ဝᕜ ҡሉ ᙽಋ : 5 ԑ Ԇ Ԥ 48%ȃ 10 ԑ Ԇ Ԥ 25%! оΰ ޟ ၥਟȂ ޱ এ Ρ ޟ ད ݲ : ӵछ Ȃ PSA ᑢᔮ ޟ Њӻ ( 圦 䛒䤴䕂䰎㙚札䟸 ḽṛ 㛺䕂㝛ᶴ濕 塾䖡㳪䕂 娵倸 圦 䤴䕂䰎 ḽṛ 㛺䕂㝛ᶴ 塾䖡㳪䕂 娵倸 䔊ỉ㜆ᶋ㗇 a 䔺䏝䑼䒃廰 濕 a 䔺䏝㛺悊㞬 㐶 ⅞濕 㗇 a 㖾䰀彂㓭 㭹䔀Ʋ н 100%)Ȃ ܚ о װ Ι ٲ ᖝ ח Ϛ१ ޟ ဝᕜ ζᑢᔮю پ, ҡ Ͻ ي ԁȃᡝᑖωȃ ጥᄚ ޟ ဝ ᘞȃ ݽ ᕛ ޟ ݷ ȇծ ӵѯᢊȃ ᕜ - ԃ ଢ଼ጥᄚ ޟ ੩ᓹ ; ઍ ޟ ߖਢ PSA ޟ ᔖҢխнᗙϚஊȂᏲम ӻш Ӕ پ ౩ џ ; ӵᄂሬᖝ ח ცΰ ; ( ٽ 33%) ޟ ဝᕜ ᘞਢϐင ఏ ᗙԤ έ ȇ ᒿ Ԟ ᘞȂ ; ᒿѶ ݽ ᕛ ߜ ȂԤᘈ ѠΡ ᙽಋ : ԃ ᓫᙽಋᇄ
榖斂恩 㗁奊 -2851$/ 2).$2+6,81* 0(',&$/ $662&,$7,21 92/ 12 Ռ ณ Ѭ ( ყ Ѳ ): A ყ ޟ Ԣጣყфߒ PSA ޟ ᡐ ϽȂζфߒရዴ ޟ ᡝᑖ ᇄ १แ ȇ ܚ оȃ ဝᕜ ҡ ڗ അԙ ޟ ԫιȂ င এ ࢲ : Ι ڧ ഋ ݽ ᕛ : Ԫк ဝ ਲ਼ଶЙ ᇄ ݽ ᕛȂ Ϟ ԤഋϷ Ԥရዴඈ ᙽ ܖ ಋȂԪਢ ܒظ ຳᅭᇌߢᘞ ݽ ᕛ (ADT) к ݽޟ ᕛПԒȂณ ՄȂӵင 2~3 ԑ ޟ ᇙТ Ȃӻኵ Ϛџᗗջ ޟ ڗ ў ޟܒת ဝ ᕜȂ ඌ ϽȂᏲम Ρ ޟ ԫι! ᐌ এ แ घ 10~ 15 ԑȅ B ყߒҰ : ܚߨٮ Ԥ ޟ ဝᕜ Ȃ Ӱ ဝᕜഅԙএ 娵倸䔊䔺䏝弞唓帇䢹 ⴲ 㯹䉅ᾃ㗇 Ʊ ⴲ 㯹䉅ᾃ㗇 ਰ ޟ ԫιȂӵ ဝᕜ ܚ ᇳ ޟ ȶ นϚЅȷ ޟ! ޟ Ռณ Ѭ Ȃএਰ џ ԫ ڏ т ޟ ӓ : ٽ ԃᑥ ȃ 娵倸䔊䕂储㿴䒃 ଽՖᔆȃЖՖᆓ ځޟ Ȍ )ȇ ဝᕜഅԙএਰ ޟ ԫι ( ყϛ ӵ Ι ଆ ဝᕜ ݽޟ ᕛ ՓԢጣ ) դਢ ӓ അԙএਰ ޟ ϞࠉȂ ר ঈџӑӱ ဝᕜ ޟ ԫι ( ՓԢጣ )Ȃк ӵఏ Ȃ
$ % ᙽಋ ޟܒ ဝᕜ! ӵռณ Ѭ ޟ Ԟ ᘞю پ Ȃи এყҰ ; ޱ ᇯ Ԥ ᘈ ϷϽ ي ԁȃ٥ᄚএ ԑӕ ݽپ ᕛԤ ؠ ר ঈ Ճ ޟ : এ ဝᕜএਰ Ԥᜰ? ౩ ΰ џо ޟ Ȃӣӑࠉඪ ᘞ ޟ ਢ ᘈȂ ٮ ϚΙ Ռณ ޟڗ кᢎᅿก ޟ Ȅԃ ݎ Ι ᘞ Ѭ ޟ ଔᘈȄᖞ ٽ Մ Ȃԃ ݎ ဝᕜ ᙽಋ ܒ ဝᕜȂ٥ ณ ᑖ
榖斂恩 㗁奊 -2851$/ 2).$2+6,81* 0(',&$/ $662&,$7,21 92/ 12 ݽ ᕛȊ Ԥএ ݽ ᕛऔጣᜰᗤ ( դቨё ဝᕜ ᘞ ޟ ጂ ܒ ᇄԃդ ޱ ᇯ ӵ έ pt3 ޟ ਢ ); ӵ Ӕ ϸа (repeat biopsy)? औጣϞࠉȂѫ ڧ ᎌ ݽޟ ᕛȂ Ҭࠉ ޟ ᔮᡛ ѓ Ԥ PCA3; џо װ ဝᕜ ݽ ᘾ ( ႀ ޟ ߝڗ ဝ ஶ (Prostate Health Index )(phi)ȅ ) ڙ Ȋ Ο ݽ ᕛऔጣȂᕜ ϐ ѪѴᗙԤ 4K Score ᇄ &RQ UP0'[ ҡሉᆒᙽಋ - ฒ ݽݲ ᘾȂѫ ᅾ໔ ( ყϤ )ȄѪΙП७ ኇ Ᏸ ޟ Ȃ ڷ ҁӓԇȅ ᇳӱ پ Ȃ ר ঈ ቄ ޣ Ў ڏ ӻ ኵਯᆄӓਏ (mpmri) ӵ ၾ ڗ ቄਢঐӔ ݽپ ᕛ ԁ? ڹ ဝᕜԞ ᘞ ޟ ՓРઉ१ Ȃ๖ ޱ ᄂሬΰζ ڗ ೨ӻএਰȂPSA 12 ӫ MRI ᇄင ޢ ဗ ॱ ݰ ኇ ᏲЕ ޟ ng/ml, ᇯ ॳᓎϚଽȂ ဝᕜ ဝϸа ( ყϲ )Ȃ ـ ᡗҰџоቨ ᄚȂ5-6 ԑ PSA Ѐଽ ڗ 40 ϗ پ ёᖝ ח १ ܒ ဝᕜ ޟ ᘞ ȂҐ ϸаȃ Φਢ PSA ϐင㘗ଽ ڗ ߖ 60 پ џఖԙ ဝϸа ޟ к ϞΙ! ng/ml( ȂԢጣଳЀ ޟ ਢ )Ȃശ ౩ տ pt3bȃ Ԥџ 䰎奜 ӔᄚΙ Ȃ ᡐԙሉ ᙽಋȃฒ ݲ ݽ ᘾ ޟ ဝᕜΟ! ဝᕜ ޟ ᘞ ޟ Ȃӵ ԑ Ԥߝ ; ޟ ဝᕜ ݽޟ ᕛ ḓ ⅞ 娵倸䔊壸㑵䕂㵔䝸 П ݲ : ԃ ᆋΦᇄվঝ ݽ ᕛ ཌഺᕛ ݲ ᇄϐԙ ဝᕜЙ ޟ к ޟ ႀ ᗶ ณ PSA ဝ ᕜ ي ޟ ԁ ҡ МՙЙ Ȃζሉሉ н ר ঈ ԑࠉ ސ ȂณՄȂPSA ΰ ЀϚΙ фߒ ဝ ᕜȂᖝ ח ΰல ޟڗ ცϞΙ PSA ϭ 4 Ս 10ng/ml ( Ը Փ Ӵ ள ) Ϟ ȂԪਢઍғԤ ဝ ᕜ ޟ Ш Ѯᢊ ޟ घ 18~ 22 % ѾѡȂһ Ԥ 75% ޟ ဝϸаȂ Ԥᐠ џоᗗջ ޟ Ȅԃ ᵒ 3&$ 僅 3+, ᶣἘ㽸 Ⅷḓ㔀Ἐ 䄅䕂䏝䄧 㣗濕 ᶔ䏝䄧 㣗 ᶣ Ⅷḓ㔀斾堿 ⵤἘ 䄅僅㓭 堿䤋㠳㭹䔀 娵倸䔊Ʋ
䰎 05, 僅䱑䖲倶㗛屃暱㮠ⸯᾍ ⷓ䕂 娵倸 䄅濕䛒䤴札䟸 ᶣ ⅞傦ⵈ悋堿 娵倸䔊䕂壸㑵䉅濕㗨 Ṅ 㗙ノ㽸 娵倸 䄅䕂 㯿ᴉ Ʋ ޟ ད! ᄇ ఏ ޟ ў ܒת ဝ Մၦਠ ᕜȂӵ 2011 ԑоࠉȃၶԥਝ ݽޟ ᕛ Ԥዉ ๙ ϽᏰ ݽ ᕛȂณՄӵ 2011 ԑо Ȃ೨ӻᄉ ޟ ݽސ ᕛച џоᡗ ߝ ޟ Ԇ ਢ : ѓ Πф๙ CabazitaxelȃᐩṞ ᒻ (Zytiga, Abiraterone acetate)ȃ Ԋ џ ۄ (Xtandi, Enzalutamide)ȃᇄ០ ( ݽ ០ 223ȇRadium-223)Ȅ ဝ ᕜ ݽ ޟ ᕛ Ճ໔ଶΟԑឭ ( Ⴑ Ꮇ ) ڼ ᇄᐌᡝ ஶ ݷޑ Ѵ, ᗙሯՃ໔ᖝ ח տȃ ੫ ܒ ᇄඈ ॳᓎȄᓍ ᚂᏰ ޟ Ȃ ငҥԞ ޟ ᘞЅӨᆍԤਝ ݽޟ ᕛП ݲ Ȃ ဝᕜ ޟ ϤԑԆ џႀ 80% 1. 埴㓧昊ġ 堃䓇䤷 悐ġ 㮹 会ġ 堃䓇䴙妰 屯㕁ġ䗴䕯䘣姀 ġ 2. Ploussard G1, Epstein JI, Montironi R, Carroll PR, Wirth M, Grimm MO, Bjartell AS, Montorsi F, Freedland SJ, Erbersdobler A, van der Kwast TH.The contemporary concept of VLJQL FDQW YHUVXV LQVLJQL FDQW SURVWDWH FDQFHU Eur Urol.2011 Aug;60(2):291-303. 3. American Urological Association (AUA) Annual Meeting Webcast 2015, 2016; AUA 080PG 059IC course handout 2015; AUA 042IC course handout 2016 4. 䀋㓅嬟儢䗴倗 屯㕁 5. NCCN Clinical Practice Guidelines in Oncology ( NCCN Guidelines) Prostate Cancer 2017 оΰȇ ដᇄடড়ᚂৱଆ, ڧ ശ ᎌӫ ݽޟ ᕛПԒ!