家庭醫業 前言 概論 7 1 101 6 100 4 2, 5 5 9 28% 183.5 1,096 2.6% 6.4 [1] 嘉醫診所院長 prostate Ca 65~75 20 80 2.2233 85 4.2463 90 6.1 693 95 8. 3 957 98 208 家庭醫學與基層醫療 第八期
8. 0 9 3 6 1 0 0 9. 4 1,096 [1] 1. 50 65 2. 3. 2~4 45~60 4. - 90 [2] 5. [3] 6. 1. 家庭醫學與基層醫療 第八期 209
2. Prostate Specific Antigen, PSA PSA 4.0ng/mL PSA4.0ng/mL 10ng/mL PSA4.0ng/mL PSA [4, 5] 3. X 4. 5. X bone scan Gleason grading system 1~51 5 [3] 210 家庭醫學與基層醫療 第八期
" " PSA [6, 7] 1. 10 2. 6 ~ 8 [8] (1) (2)(3) (4) (A) (B) 10 家庭醫學與基層醫療 第八期 211
(A) (B) (C) (D)10 (A) (B) 3. PSA ionization radiation 3 [9] (A)2D (B) i n t e r s t i t i a l implantation (C) 3 D CRT (D) i n t e n s i t y modulate radiation therapy, IMRT 212 家庭醫學與基層醫療 第八期
(A) 3~4 1~2 (B) ~ 4. (A) PSA (B) 1 a cyproterone acetate Androcur flutamide Fugerel, bicalutamide Casodex [10] b diethylstilbestrol DES clhrh LHRH testosterone LHRH LHRHLH testosterone 1~2 LHtestosterone 家庭醫學與基層醫療 第八期 213
leuprorelin acetate Leuplingoserelin acetate Zoladex 1~2 (2) (3) [10] 1 0 ~ 1 5 5. PSA vinblastine vinorelbine mitoxant rone paclitaxel P S A 6. 196 90 214 家庭醫學與基層醫療 第八期
90 60~70 6 5 3 5 ~ [11] (A) 5 3 ~ 6 P S A 6 ~ 1 2 PSA PSA (B) 3 PSA 3 GOT GPT 3~62 PSA Vi t D, bisphosphonates 1. 50 PSA 2~4 45 PSA 2. 3. 家庭醫學與基層醫療 第八期 215
結語 5 0 50 參考資料 1. 100 2011 5 11 2. Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ: Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst. 1996; 88: 1118-26. 3. 2012 5 201-8 4. Han M, Macairan ML, Lieu P et al: Prostatespecific antigen and screening for prostate ca. Med Clin North Am. 2004; 245-65. 5. Sutcliffe S, Platz EA: Inflammation and prostate cancer: a focus on infections. Current urology reports. 2008; 243 9. 6. Hernandez J, Stephenson RA, Stanford JL et al: Diagnosis and treatment of prostate ca. Med Clin North Am. 2004; 267-79. 7. McPhee SJ, Papadakis MA: Current medical diagnosis & treatment. 2008; 1422-8. 8. Ward JF, Zincke H: Radical prostatectomy for the patient with locally advanced prostate cancer. Curr Urol Rep. 2003; 4:196-204. 9. Brenner DJ, Curtis RE, Hall EJ, Ron E: Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer 2000; 88:398-406. 10. Robson M, Dawson N: How is androgendependent metastatic prostate cancer best treated? Urology 2002; 60:3-11. 11. Cooperberg MR, Broering JM, Carroll PR: Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. Cancer. 2009; 101:878 87. 216 家庭醫學與基層醫療 第八期