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1、Carcinoma of prostateEpidemiology(流行病学） The morbility is very high in the west country, it is the most high incidence of the males. more prevalent in black males The second disease which cause death The disease incidence is becoming higher and higher in China 2015年美国预测发病人数220,800人Globoscan statistic
2、s,2012, CA Cancer J Clin 2015;00:00-00etiology （病因学） The cause of prostate cancer is still unknown genetic, hormonal, dietary, environmental influences. (遗传、内分泌、饮食、环境因素） positive family historypathology 98% are adenocarcinoma （腺癌） Others are transitional-cell carcinoma （移行细胞癌） squamous-cell carcinom
3、a （鳞状细胞癌） undifferentiated carcinoma （未分化癌）pathology 60-70% peripheral zone 10-20% transition zone 5%-10% central zone Gleason score: 2-4 well differentiation 5-7 moderate differentiation 8-10 poor differentiation, more maligantmetastasis hematogenous metastasis :vertebral column, pelvis lymphatic m
4、etastasis direct invasionSymptoms and signs No symptoms : early stage bladder outlet obstruction 60% Previously: 50% with the signs of metastases Now: fewer than 20%, because of earlier diagnosis terminal symptoms Anemia 贫血 Asthenia 衰弱 edema of lower extremity 下肢浮肿 Difficult defecation 排便困难 Osteodyn
5、ia 骨痛 Fracture 骨折 Spinal compression 脊柱压迫stagingCan not feel by the finger How to diagnose the PC?Laboratory findings Prostate-specific antigen(前列腺特异性抗原，PSA） is elevated in 60% patients PSA above 4ng/mL is abnormal Methods for enhancing PSA: 参考正常值 age-specific PSA 0.75ng/(mly) PSA density 0.15 perce
6、nt-free PSA 16% Total PSA is useful for staging, but not absoluteDRErectal touch DRErectal touch Imaging examination Transrectal ultrasound(经直肠超声检查TRUS): typical hypoechoic peripheral zone lesions intravenous urogram（尿路造影） : urinary retention or ureter obstruction Chest or abdominal x ray: metastase
7、s of bone CT: enlarge prostate and lymph nodes MRI: more helpful in staging of prostate cancer Transrectal ultrasound(经直肠超声检查)MRICT scanBiopsy and grading Ultrasound guided prostate biopsy Graded by the Gleason score Gleason score: more high more aggressivetreatment Watchful waiting (严密观察） Surgery （
8、手术治疗） Endocrine therapy （内分泌治疗） radiotherapy （放疗） chemotherapy （化疗）Watchful waiting In the operation of benign prostatic hyperplasia and find incidental carcinoma stage Gleason score: lowoperation Radical prostatectomy （根治性前列腺切除术） : early stage patient: stage and open operation laproscopic operation
9、 indications ： expected life longer than 10 yearsindications laproscopiclaproscopic radical prostatectomy glandula seminalisurethra glandula seminalisradiotherapy internal radiation therapy （放射性核素粒子（如I125）植入内照射）：stage external radiation therapy (外照射） local control new opinion: radical radiotherapyin
10、ternal radiation external radiation 2008 world Richest man 2012 diagnosed PC external radiation therapyHealthy nowEndocrine therapyStage and stage male castration（睾丸切除）: not androgen deprivation male castration（睾丸切除） + Androgen preparation（抗雄激素制剂）analog of leuteinizing hormone releasing(促黄体激素释放激素类似物，LHRH-A) + Androgen preparation estrogen (second line)others（雌激素和其他）chemotherapy If the endocrine therapy is failure, chemotherapy may be helpful. New method. Cryotherapy, Irreversible electroporation new drug : Antiandrogen, Targeted therapeutic agents
