Management of Localized Prostate Cancer课件.ppt

Management of Localized Prostate Cancer 仁济医院泌尿外科 陈勇辉 Case History 患者 男性 55岁 因PSA 5.2 ng/mL （2年前PSA 2.0 ng/mL ）DRE没有异常发现(stage T1c)，穿刺活检显示：发现肿瘤（4/8）， Gleason 3+4 = 7 。 而后进行耻骨后前列腺癌根治术。病理显示：双侧Gleason 8分, 局部侵及包膜外,未累及精囊，切缘、淋巴结均为阴性。 分期 T1c - Tumor identified by needle biopsy (because of elevated PSA level); tumors found in 1 or both lobes by needle biopsy but not palpable or reliably visible by imaging T3a - Extracapsular extension (unilateral or bilateral) 主持讨论专家 Eric A Klein, MD Professor of Surgery Cleveland Clinic Lerner College of Medicine Management of Prostate Cancer, 2nd Edition: Edited by Eric A Klein MD 主持讨论专家 William K. Oh, MD Assistant Professor of Medicine, Harvard Medical School 主持讨论专家 W. Robert Lee, M.D. Associate Professor and Vice Chairman of Radiation OncologyAttending Physician, North Carolina Baptist Hospital Further immediate treatment ？ A No adjuvant therapy B Adjuvant radiation therapy to the prostate bed C Adjuvant radiation therapy to the prostate bed and whole pelvis D Immediate androgen deprivation therapy E Clinical trial of chemotherapy RESULT 50% No adjuvant therapy 0% Adjuvant radiation therapy to the prostate bed 25% Adjuvant radiation therapy to the prostate bed and whole pelvis 25% Immediate androgen deprivation therapy 0% Clinical trial of chemotherapy Case History (continued) 术后 PSA 下降至 0.1 ng/mL。 但是，术后 18个月 PSA 为 0.2 ng/mL。 病人感觉良好，无任何不适症状。 性欲如常，服用万艾可能正常勃起。 What do you recommend? A No treatment? B Salvage radiation therapy to the prostate bed? C Immediate ADT? D Cryosurgery? E Chemotherapy F Clinical trial? RESULT 50% No treatment 50% Salvage radiation therapy to the prostate bed 0% Immediate ADT 0% Cryosurgery 0% Chemotherapy 0% Clinical trial Salvage therapy Patients who have PSA (biochemical) failure following radical prostatectomy and have no evidence of metastatic disease have the options of watchful waiting, radiotherapy,