摄护腺癌手术治疗.ppt

攝護腺癌的手術治療 攝護腺癌 根據行政院衛生署的統計，國人攝護腺癌的發生率與死亡率正逐年增加。2000年後，國內每年有超過千位新病例被診斷出罹患攝護腺癌；2003年，攝護腺癌死亡率已躍升至國人男性癌症死亡十大疾病第七位。 1979年，國內僅有98位攝護腺癌新病例，到了1995年已上升至884位，年齡標準化發生率達7.2人/十萬人口。1995年，國人有371位男性因攝護腺癌死亡；1998年，有540人死亡，死亡率為4.82人/十萬人口，粗發生率為14.25人/十萬人口，佔男性癌症發生率第六位；到了2000年，有635人死亡，死亡率為5.59人/十萬人口；到了2003年，有742人死亡，死亡率為6.45人/十萬人口。 台灣地區主要死亡原因(2003) 台灣地區癌症死亡原因(2003) 台灣地區癌症死亡原因(2003) TNM Staging System for Prostate Cancer TNM Staging System for Prostate Cancer (CaP) Localized disease: T1 and T2 Locally advanced disease: T3 Metastatic disease Treatment of CaP Localized disease (T1 T2): Radical prostatectomy Watchful waiting - older patients - very small, well-differentiated cancers Radiation therapy - external beam therapy (6500-7000 cGy) / 3-D - brachytherapy (for low-volume, low-grade CaP) Cryosurgery - for T1c , PSA10 ng/mL Radical Prostatectomy Radical prostatectomy (RP) is a curative treatment for localized prostate cancer, which consists of removing the prostate and seminal vesicles, after bilateral ilio-obturator node dissection. The aims of RP are to ensure oncological control, to preserve continence and sexual potency (when possible) and to minimize morbidity. Radical RetropubicProstatectomy Treatment of CaP INDICATIONS for radical prostatectomy(RP): Localized CaP (clinical stage T1-2N0M0) Life expectancy 10 years Prognoses of CaP Treated with RP Radical Prostatectomy- milestone 1st generation: Open Surgery 1905, Hugh Hampton Young – radical perineal prostatectomy 1945, Millin – radical retropubic prostatectomy 1983, Walsh – nerve-sparing radical retropubic prostatectomy - 1,945 men who underwent radical prostatectomy between 1982 and 1996 Walsh PC. J Urol, 163(6):1802-7, 2000 1st generation: Open Surgery CONCLUSIONS: There is no better way to cure organ confined cancer than total surgical removal. Today continence and potency rates should be high. Laparoscopic versus open radical prostatectomy: Laparoscopic versus open radical prostatectomy: