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Spring 1999 癌症論談 z 簡介攝護腺癌 z 攝護腺癌的早期偵測 z PSA 在攝護腺癌診斷的角色 z 攝護腺癌病人與家屬須知 z 攝護腺癌治療方法的遠擇 z 攝護腺癌的內科治療 z 我的攝護腺癌就醫經過 z 攝護腺癌統計資料 z 攝護腺辭彙對照

Spring 1999 論 Cancer Information /...1 /...2 PSA /...5 - 理 / 玲...7 療 / 李...15 療 /...21 路 My Story /...23 欄 Special Editorial 料 / 理...24 / 李...27

City of Hope 流行年來不 1998 年例 184,500 例 39,200 年切例罹率 100.2/100,000 0.4/100,000 數年年來流行聯不說易罹 Leydig Androgen 95% 來 5% 來 2% 離行理 2% 度刺不不易離力異罹罹率 Luteinizing Hormone Releasing Hormone(LHRH) 來刺淋行見見淋療不 PSA 行切不不類度療療療見論論 99 Spring 1

1997 年 209,900 罹 41,800 36% 數 13% 罹率率兩數 19% 北北來 1988 年 1992 年 PSA 數數降年率 PSA 率連行率年率 1992 年 50 DRE PSA 不年臨料論來行臨料率不不 1992 年 1997 年六年 50 年年 PSA DRE 2 論 99 Spring

料列料 50 烈例來說兩罹例 45 年更料狀率立 PSA 不 4.0 / g/ml PSA 良 DRE 練行識異度更 DRE PSA 更 PSA 料年更例來說 4.0 PSA 不不 25% PSA 4.0 良不 PSA PSA 不療來療惡度論年 PSA 率烈 PSA 不臨狀老年臨狀 50 料 PSA 度論 PSA 4.0 不 PSA 度 80% 29% 良數 25% 良量惡率率來料 PSA 臨臨不療療療療療療切療力率切療數年年理不論 99 Spring 3

年 PSA / 類聯理復行行例療 PSA 良不 PSA 度 PSA 度 PSA PSA 離 PSA 年 PSA PSA PSA 惡力 PSMA 例尿數例更臨更度率降數率料更更例 1997 年 ACS 1992 年識旅里不更識狀 American Cancer Society Guidelines for Early Detection of Prostate Cancer 1997; Vol. 80, No 9; 1805-1807 料北 4 論 99 Spring

PSA City of Hope 利 PSA PSA 說便 1993 年 PSA 療 CEA 來什 PSA PSA 糖 93% 7% 糖泌來 1981 年 Papsidero Wang 兩便什 PSA 了塞良 PSA 0 4ng/ml PSA 尿 PSA 度切更 PSA 4 6 例 Finasteride 降 PSA 見 PSA PSA 理 PSA 3 不 PSA PSA PSA Yang (Pros-check) (Polyclonal); Hybritech (Tandem-R) (Monoclonal); Abbott(IMX) Polyclonal/Monoclonal 臨行 IMX 不不切 free 離 PSA Bound( )PSA 不 PSA 泌 -2-macroglobulin -1-antichymotrypsin 來 Bound Free PSA PSA 論 99 Spring 5

行切 PSA velocity PSA density 便 PSA 不參 0-5.5 參 Walter Reed/Center for Prostate Disease Research PSA 老年切 PSA 臨 PSA 4.0ng/ml 異 4.1 10.0 1/3 PSA 10.0 2/3 PSA 數年 PSA 例 40-49 PSA 0-2.0 70-79 PSA PSA 年論 1. 50 尿尿 PSA 2. 40 6 論 99 Spring

\ 玲什列尿狀粒量 20 不泌量狀量金力力泌尿行流尿度不見不了說惡來 Cancer 類兩數裂復律良復力亂了了良惡良不切不復不惡論 99 Spring 7

惡離淋切了復切來來說 95% 1. 年六類老老 4. 裂異力刺惡來來來年切不更不切 5. 說不易罹罹率量 2. 不易罹年來 3. 度罹年年六若 6. 金不例露狀狀了尿路狀良狀列見狀尿不易尿尿 8 論 99 Spring

尿尿流尿尿裡狀不罹狀例良尿路立理狀例力便狀行 1. 理率不 2. 異 Prostate specific antigen PSA 臨度異不良 PSA PSA 3. transrectal ultrasonography TRUS 六臨不例來數不練淋來臨 4. 切立切切 Biopsy gun 切切了刺論理行尿尿切尿切裡尿切尿理切來論 99 Spring 9

度了了來療了了 1. X 2. 3. 淋 4. 力裡 X 來 5. 列泌尿 X 尿塞兩泌尿 ABCD TNM 例淋來說度易 ABCD A 行尿行 A1 良 A2 B B1 B2 C C1 C2 D D1 淋 D2 療療療狀療見療數更療識療療料論療療行尿度療療列不漏 <> 療療什療什療 10 論 99 Spring

說更來參論令療不切論不不療療了療療兩療療聯 1 療療泌尿療 2 療療 3 利例金路 A1 了尿不立療切切切淋尿兩行切切裡切淋切來切切裡切淋不年尿老療 A B 療療量來殺療療療療療療行療療禮連禮度療裡見復行療不見療來療例不老行切數 C 療療療兩療療論 99 Spring 11

療療療理不療療療度不療狀了療切來來女來女 diethylstilbestrol(des) 泌理裡泌 Leuplin Depot Zoladex Decapepty 切療不量 Androcur Fugerel Megace 療年量不療不了療療療療來不易不療療療不力療尿率降了留泌尿了尿年復力尿不行裡不行療療量療行療量尿尿療 12 論 99 Spring

療量量不療療療率療療不療行切療更狀惡來度降量療療不療降不不療更良療量力裡療復更療 X 尿理罹怒連串理來療來不不論療療切更了療療療裡更來參數復率數來數論 99 Spring 13

數來狀立論論不來易裡療識見不療來不了論見裡行臨來老年例不年了療 1. 70% 不 2. 異 PSAPSA 度 PSA 度不不不 PSA 3. 切力不不療更更療療療療來療不了力療療力金 14 論 99 Spring

療李洛 Good Samaritan Hospital California Hospital Medical Center Department of Radiation Oncology 類數, 率率數來罹不率年來更列率陸數令? Digital Rectal Examination, DRE 年 Prostate Specific Antigen PSA 狀了年易療說識說來療行老年理年老不流療了不流利了論說理說理了立了參 Prostate 什列泌利不來不不行來論 99 Spring 15

不來來尿尿良惡尿良良 Benign Prostatic Hypertrophy, BPH 什泌尿切尿塞良泌尿來了惡不不切尿切了便尿切尿什切切 Radical Prostatectomy 來年金 P. Walsh 切 Nerve Sparing Radical Prostatectomy Walsh 尿切行切切便不列療 Radiation Therapy 論療理療來切療理殺不來說療療年來數來論率率療切兩療切療兩療度臨 Randomized Trial 行泌尿不療異療略切療見 Nonbiased Comparison 不臨見來切切不來 16 論 99 Spring

臨來理來率六例切療療臨不例療降不療切不了了論 National Institute of Health 年行了論識 Consensus Statement, 兩療年率令不什泌尿列論數年療 I. Tannock 了療立了兩泌尿了泌尿切切療見狀什不見僚行見行利力钜不不了療行不流見療療泌尿來切了 PSA PSA 泌不良惡 PSA PSA 切理 Gleason Score 量惡度 T Stage 數來率療年來量臨料理來參金 A. W. Partin 更金 M. Roach 了列率 % = 3/2 x PSA + ( Gleason Score 3 ) x 10 率切療率切不論 99 Spring 17

\ PSA 不來療更來量療復理論來療切料 PSA 泌療留 PSA 數不論療 PSA 來了不 PSA 利療復狀了 PSA PSA 數理力什療不 PSA 臨狀年 PSA 療復療療來惡見利 PSA 來見見臨參療狀年理狀來 PSA T Stage, Gleason Score 來療度不療 T1 T2 年年年率 PSA Gleason Score 便療不力療切 Radical Prostatectomy T1 T2 年年率 Partin 來 PSA Gleason Score 療療療 Radiation Therapy 不 T1 T4 率臨不 Distant Metastasis 療率參 Partin PSA Gleason Score 率療療來句不離行來療理念 T1 T2 切理年來 18 論 99 Spring

療六不六六 cgy 量了了 PSA 量來 PSA 不臨率切泌尿率療 PSA 率不論不不省更療力來量 PSA 降切了了 T2b 更列例讀立療 Conformal Radiotherapy 量來度度理 Medical Physicist 量量不狀療流更令異利來量療來度量狀 Intensity Modulated Radiation Therapy (IMRT) 度療說不理不數年來療 Treatment Planning System 理什度量率量 Forward Planning Inverse Planning 量理來療理度立了里療不療 Proton Radiotherapy 量療 Photon X rays 不量度狀量來立更療離療 Heavy Ion Radiotherapy 不不理不療力量數 Loma Linda 療 Neutron Radiotherapy 離理力力不論 99 Spring 19

識療不療臨不 Wayne State 識良更療來療理行療 Brachytherapy 療歷禮金惡離來不理年來利 Transrectal Ultrasound 來療了泌尿療療泌尿療便說療略兩 Permanent Radioactive Seed Implant 量率 (Low Dose Rate) 粒金利療量率 (High Dose Rate) (Temporary Implant) 療 (Remote Afterloader) 量率療量兩來療離療 Teletherapy 立療異量療來力率 PSA 率了療臨 T2b 兩療療率療療療切療療療 Hyperthermia, 療 Hyperfractionated Radiotherapy, Radiation Sensitizer 了良療了利不令療略了理練來不療 20 論 99 Spring

療 City of Hope Y.A.K. Consultry Inc. 療切療療療療 / 療療療療兩類女 DES 來 LHRH 泌 DES 易塞不年來 Lupron 3-4 / LHRH 療療來療泌 A 兩切兩切降行年行理不不行 B 泌 Luteinizing Hormone Releasing Hormone (LHRH) LHRH 療 C. 例 Flutamide Eulexin, 250mg Bicalntamide, 200mg daily,nilutamide 類不異切 Flutamide Lupron Lupron Flutamide 量 Lupron Flutamide Lupron 率 25% 論 99 Spring 21

D. 療切淋 / PSA 療療療不療臨易來療切療 A. 療療療 PSA 不 50% 兩療療見療不不 PSA 年類療不療度療 Orchiectory Lupron 療 Lupron 療 Orchiectory 療見淋 B. 療療不立療 1-4 行療立降 50% PSA 狀降 PSA 不理療不 PSA 降復數 C. 療不療兩年年來療療更年療不年來療臨說力 mitoxantrone (12 mg/m 2 IV holus 93 wk) prednisone 5 mg twice daily 29% 年 mitoxantrone 療 Estramustine Taxol etoposide pienta Estramustine etoposide 療 1 年 40% 22 論 99 Spring

路 My Story 1988 年例行異 PSA 9.2 0~4 泌尿切說年 1988 年年泌尿切了年理裡泌尿 PSA 11.0 年切葉參狀泌尿柳來兩兩 PSA 降 2.7 說 60 裡 X 療療說狀療離泌尿說 PSA 10 療切療療了論 99 Spring 23

歷年 / 理 California Cancer Facts & Figures 1996 1997 1998 1999 列率 1988-1992 Lung Cancer Colorectal Cancer Prostate Cancer Liver Cancer Oral Cancer 1990-1994 Prostate Cancer Lung Cancer Colorectal Cancer Liver Cancer Oral Cancer 1989-1993 Lung Colorectal Cancer Prostate Cancer Liver Cancer Oral Cancer 1991-1995 Prostate Cancer Lung Cancer Colorectal Cancer Liver Cancer Oral Cancer 年率數 All Stages % Local % Regional % Distant % 1986-1991 85 98 92 30 1986-1992 87 99 93 30 1986-1993 89 100 94 31 1989-1994 93 100 99 33 Cancer Facts & Figures 1996,1997,1998,1999 24 論 99 Spring

1999 年 Cancer Information * 罹數 * * 數 * Prostate 179,300 Lung & bronchus 94,000 Colon & rectum 62,400 Urinary Bladder 39,100 淋 Non-Hodgkin lymphoma 32,600 Melanoma of the skin 25,800 Oral cavity 20,000 Kidney 17,800 Leukemia 16,800 Pancreas 14,000 Lung & bronchus 90,900 Prostate 37,000 Colon & rectum 27,800 Pancreas 13,900 淋 Non-Hodgkin lymphoma 13,400 Leukemia 12,400 Esophagus 9,400 Liver 8,400 Urinary Bladder,100 Stomach 7,900 數 All Sites 623,800 數 All Sites 291,100 論 99 Spring 25

罹數數 * 罹數 * San Diego/ San Francisco Central Los Angeles Orange Imperial Bay Area Valley County County Counties 1988 1726 955 813 1270 1989 1779 1065 6479** 929 1305 1990 2001 1266 4073 1080 1606 1991 2682 1541 5457 1416 2076 1992 3080 1893 6487 1754 2360 1993 2919 1654 5930 1708 2089 1994 2594 1383 5044 1292 1723 1995 2469 1282 4646 1210 1616 1996 2570 1258 4556 1296 1621 * 數 * San Diego/ San Francisco Central Los Angeles Orange Imperial Bay Area Valley County County Counties 1988 403 198 185 269 1989 436 222 1534** 170 265 1990 438 264 734 207 279 1991 451 262 793 236 352 1992 469 274 843 241 300 1993 494 251 862 233 326 1994 445 283 903 254 317 1995 473 257 803 202 294 1996 463 260 794 209 297 ** 數 1988 1989 From Cancer Surveillance Program for Cancer Control San Francisco Bay Area, Central Valley, LA County, Orange County, San Diego/Imperial Counties, 1999 26 論 99 Spring

Cancer Information 李 Adenocarcinoma - 惡 Extracapsular Extension Adenoma 良 Flare 療 Adjuvant Therapy 療 Flutamide Eulexin Adrenal Gland Foley Catheter 尿尿 Androgen Gleason Grade - Antiandrogen Gleason 量惡度 Benign Prostate Hypertrophy (BPH)- 數惡度良 Gleason Score Biopsy 切兩 Gleason Grade Bladder Neck Gleason Score 數 Bone Scan Gynecomastia Brachytherapy 療療 Capsule Heavy Ion Radiotherapy 離療 Casodex Bicalutamide High Dose Rate (HDR) Brachytherapy - Castration 切量率療 Clinical Staging 臨 Hormonal Therapy 療 Conformal Radiotherapy 立療 Hot Flashes 療 Cystitis Hyperthermia 療 Cystoscopy Hypothalamus Digital Rectal Examination (DRE) Impotence Incontinence 尿 Erectile Dysfunction 不 Intensity Modulated Radiation Therapy (IMRT) - External Beam Radiation Therapy 療度療論 99 Spring 27

Interstitial Radiation Therapy 療 Prostatectomy 切 Laparoscopic Pelvic Lymph Node Dissection Prostatitis 淋 Radiation Oncology Libido Radiation Therapy 療 Lupron Leuprolide Radical Prostatectomy 切 Luteinizing Hormone Releasing Hormone(LHRH) Radioactive Seed Implant 療刺 Radiotherapist 療 Lymph Nodes 淋淋禮 Radiotherapy 療 Medical Physicist 理 Rectum Metastasis Recurrence 復 Neoadjuvant Hormonal Therapy 療 Remote Afterloader 療 Nerve Sparing Radical Prostatectomy Salvage Therapy 療切 Scrotum Neurovascular Bundles Seminal Vesicle Neutron Therapy 療 Staging Nocturia 尿 Temporary Implant 療 Orchiectomy 切 Testicles Organ-confined Total Androgen Blockade Pathological Staging 理 Transrectal Ultrasound(TRUS) Pelvis Transurethral Resection of Prostate(TURP) Penis 尿 Perineum Ureter 尿 Periprostatic Tissue Urethra 尿 Permanent Implant 療 Urgency 尿 Pituitary Gland Urinary Hesitancy 尿 Proctitis Urinary Incontinence 尿 Proscar Finasteride Urinary Frequency 尿尿 Prostate Urinary Retention 尿塞留 Prostate Acid Phosphatase(PAP) Urine 尿 Prostate Cancer - Urology 泌尿 Prostate Specific Antigen(PSA) 異 Watchful Waiting Zoladex Goserelin 28 論 99 Spring