攝護腺癌可怕嗎？prostate cancer really terrible?

攝護腺癌可怕嗎？prostate cancer really terrible?

攝護腺位於膀胱下方並包繞著尿道，健康的攝護腺只比栗子稍大。

攝護腺癌好發於老年男性，在歐美發病率高，居男性惡性腫瘤發病率第一位、死亡率第二位。

與西方國家相比，我國更多的攝護腺癌患者在確診時已是進展期。

因生活方式西方化和人口老齡化，近年來我國攝護腺癌發病率逐年上升。

攝護腺癌危險因素尚未完全明確，但與年齡、種族、高脂肪飲食、家族史等有密切關係。

Prostate surrounds the urethra just below the urinary bladder and a healthy prostate is classically said to be slightly larger than a walnut. Prostate cancer (PCa) is common in elderly men. It is the most common cancer in elderly men in western countries while its mortality ranks second among all kinds of tumors. Compared with the western countries, a larger proportion of confirmed cases is at an advanced stage in China. What’s more, with the popularity of western food style and greater proportion of elderly men, the incidence of PCa has been increasing in recent years in China. The factors that determine the risk of developing PCa are not well known, but now a few have been thought to have a considerable relation with it, which includes increasing age, ethnic origin, high-fat diet, genetic predisposition etc.

攝護腺癌早期多無明顯症狀，但由於攝護腺包繞著尿道，所以攝護腺癌有時可引起不同程度的下尿路症狀，包括尿頻、尿急、排尿困難、甚至血尿，尿痛等，與良性攝護腺增生難以鑑別。

直腸受壓時還可出現排便困難。

攝護腺癌轉移至身體其他部位時可引起轉移灶的症狀，部分患者是以轉移灶的症狀就醫，而無攝護腺局部原發症狀。

最常見的轉移灶症狀是骨痛，多發生於椎骨、骨盆或肋骨。

在一些病例中，轉移性攝護腺癌可引起病理性骨折，甚至截癱。

Early PCa usually has no specific symptoms. However, since anatomically the prostate gland surrounds the prostatic urethra, sometimes PCa does cause a series of lower urinary tract symptoms (LUTS), including urinary frequency, urgency, difficulty to void, and even hematuria (blood in the urine) and dysuria (painful urination), which make it difficult to do differential diagnosis between benign prostatic hyperplasia (BPH) and PCa only by symptoms. PCa may also cause difficulty in defecation when it involves rectum. Metastatic PCa can cause symptoms related to metastasis places. Some patients come to see a doctor because of metastasis symptoms, instead of symptoms from prostate. The most common metastasis symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or ribs. In some cases, metastatic PCa can even cause pathological fracture or even paraplegia.

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如何檢查？How to examine?

直腸指檢 DRE

直腸指檢+血清攝護腺特異性抗原（PSA）檢查是目前公認的早期發現攝護腺癌最佳的初篩方法。

絕大部分攝護腺癌發生於外周帶，直腸指診易於發現。

規範的直腸指診應包括：攝護腺大小、表面是否光滑、腺體的質地、中央溝情況、有無結節。

DRE and prostate specific antigen (PSA) test are the best way to detect PCa in an early stage. Most PCa are located in the peripheral zone of the prostate and can detected by DRE. A standard DRE description should include the size of prostate, surface smoothness, gland texture, central sulcus, and presence of nodules.

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血清攝護腺特異性抗原（PSA） Prostate Specific Antigen (PSA)

PSA是一種器官特異性而非腫瘤特異性標記物。

攝護腺炎、良性攝護腺增生和攝護腺癌均可導致總PSA水平升高。

血清總PSA水平＞4.0ng/ml為異常，血清總PSA水平越高，攝護腺癌的可能性越大。

為防治假陽性，PSA檢查應在直腸指診後1周，膀胱鏡檢查、導尿等操作48小時後，射精24小時後，攝護腺穿刺1個月後進行。

PSA is an organ- but not cancer-specific biomarker. It is abnormal when the serum total PSA (tPSA) is more than 4.0ng/ml. The higher the tPSA value, the more likely the existence of PCa. To avoid false positive results, PSA test should be done 1 week after DRE, 48 hours after cystoscopy and catheterization, 24 hours after ejaculation, and 1 month after prostate biopsy.

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經直腸超聲 Transrectal Ultrasound (TRUS)

經直腸超聲和核磁共振（MRI）等影像學檢查可以作為輔助診斷的手段。

經直腸超聲典型的攝護腺癌徵象是外周帶存在低回聲結節。

經直腸超聲雖簡單易行，但是在診斷攝護腺癌方面的敏感性和特異性並不十分理想，因此不可替代其他檢查。

Transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) can be used as supplementary diagnostic methods. The classic image of PCa in TRUS is a hypo-echoic area in the peripheral zone of the prostate. Though TRUS is easy to do in the clinic, both its sensitivity and specificity are not adequately reliable in detecting PCa. Therefore it cannot take the place of other diagnostic tests.

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核磁共振 Magnetic Resonance Imaging (MRI)

MRI在攝護腺癌診斷中的敏感性高於CT。

MRI可顯示攝護腺包膜的完整性、及盆腔淋巴結受侵犯情況，對於臨床分期有重要意義。

The sensitivity of MRI is higher than that of CT scan in PCa diagnosis. MRI can show the integrity of the prostate capsule and the involvement of pelvic lymph nodes. It can help with determining the stage of disease.

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攝護腺穿刺活檢 Prostate Biopsy

攝護腺穿刺活檢是確診攝護腺癌的金標準。

首次增高的PSA水平不應該提示立即進行攝護腺活檢，而應該於幾周後在同一實驗室、同一標準實驗條件和同一實驗方法下再次檢測PSA水平。

目前認為標準的攝護腺穿刺活檢應在超聲的引導下完成。

攝護腺穿刺活檢的指征包括直腸指檢發現異常結節；影像學檢查發現異常影像；PSA＞10ng/ml；PSA介於4~10ng/ml， fPSA/tPSA＜0.15等。

Prostate biopsy is the gold standard for diagnosis of PCa. The PSA level should be verified after a few weeks in the same test condition, using the same methods. It is now considered as the standard way to perform prostate biopsies under ultrasound guidance. The indications for a prostate biopsy are: nodule detected by DRE, TRUS and/or MRI reveals abnormal images, PSA > 10ng/ml, PSA is between 4~10ng/ml and fPSA/tPSA < 0.15, etc.

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攝護腺癌的早期診斷依賴於在高危人群中進行適當的篩查，並且嚴格根據指征進行攝護腺穿刺活檢。

因此，大家不必談癌色變，更不必盲目地進行攝護腺癌的過度篩查。

早期攝護腺癌只要得到及時、正確的治療和干預，基本都可獲得令人滿意的預後。

The early diagnosis of PCa mainly relies on the adequate screening in high risk people, and prostate biopsy in highly selected patients. There is no need to do over diagnosis. Once PCa is detected in an early stage and treated on time, most of the patients can have a good prognosis.

文章來源：仁濟醫院國際醫療RenjiHospital

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