AUA前列腺癌介紹PPT課件

1、關(guān)于前列腺癌的文獻(xiàn) 數(shù)量多，分類細(xì) 臨床隨訪數(shù)量多，資料翔實(shí) 涉及的領(lǐng)域比較廣泛第1頁/共36頁問題1 前列腺癌根治術(shù)（RP）、前列腺癌外放射治療（EBRT）、前列腺癌近距離照射治療（brachytherapy）這三種方法治療效果的比較？第2頁/共36頁問題1 10,472 patients with localized prostate cancer at Cleveland Clinic and Barnes-Jewish Hospital. radical prostatectomy (N=6493) EBRT (N=2260) brachytherapy (N=1719) 285 OV

2、ERALL AND CANCER SPECIFIC URVIVAL FOLLOWING DEFINITIVE THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER IN THE PROSTATE-SPECIFIC ANTIGEN ERA第3頁/共36頁問題1 EBRT and brachytherapy were significantly associated with diminished survival (HR 1.6 95% CI: 1.4-1.9 and 1.7 95% CI: 1.4-2.1, respectively; P 0.001

3、)compared to radical prostatectomy after adjusting for biopsy Gleason score, PSA, age, comorbidity, ethnicity, and clinical stage. 第4頁/共36頁問題1 EBRT and brachytherapy were also associated with a significantly higher rate of androgen-deprivation therapy (P 10 years with an undetectable PSA after RP+PL

4、ND alone. However, the extent of PLND remains controversial.第8頁/共36頁問題2 Using a full PLND (external iliac, EI; obturator, O; and hypogastric, H), Studer reported that only 37% of patients with +LN would be identified if PLND was restricted to the EI area above the obturator nerve (the typical limite

5、d PLND performed in the US).第9頁/共36頁問題2 Over a 6 year period a single surgeon (PTS) submitted the PLN as separate packets during open RP in a consecutive series of 613 patients who received no prior therapy for prostate cancer. A full PLND was performed as described above.第10頁/共36頁問題2 Thirty-five pa

6、tients had +LN (8.2%), with a median of 16 (range,2-52) nodes removed. The median number of +LN per patient was 2 (range, 1-10). Nearly half (49%) of men had only 1 +LN, 31% had 2 and 20% had 2 +LN. The EI, O and H regions had positive nodes in 37%, 60% and 49% of patients (figure).第11頁/共36頁第12頁/共36

7、頁問題2 Venous thrombo-embolism (VTE) is a source of serious morbidity and mortality after radical prostatectomy (RP). Pelvic lymph node dissection (PLND), traditionally a routine part of RP, may be related to the development of VTE.1951 PELVIC LYMPH NODE DISSECTION IS ASSOCIATED WITH VENOUS THROMBOEMB

8、OLISM RISK DURING LAPAROSCOPIC RADICAL PROSTATECTOMY第13頁/共36頁問題2 The records of 773 consecutive patients who underwent laparoscopic radical prostatectomy (LRP) by a single surgeon from 2001-2009 were reviewed for postoperative VTE. 469 patients (60.7%) underwent LRP+PLND; 304 underwent LRP only (39.

9、3%). VTE occurred in 7/469 LRP+PLND patients (1.5%), and in 0/304 LRP-only patients (0%) (p=0.046). Surgical approach (extra- or trans-peritoneal) and cancer stage were not risk factors for VTE. Only 4/469 (0.9%) men had positive lymph nodes.第14頁/共36頁問題2 PLND during LRP may increase the risk of VTE

10、without providing an obvious cancer control benefit in most patients with clinically localized prostate cancer. Our data argue that PLND should be judiciously rather than routinely performed on patients at extremely low risk for LN metastasis.第15頁/共36頁問題2 Despite the lower incidence of +LN in our se

11、ries, the distribution of +LN was identical to Studers. The O and H were the only sites of +LN in 31% and 26% of our patients, so a PLND limited to the EI area, above the obturator nerve, would miss more than half of contemporary RP patients with +LN. Whenever PLND is indicated during RP, a full PLN

12、D should be performed.第16頁/共36頁問題3 前列腺癌根治術(shù)后切緣陰性的患者腫瘤復(fù)發(fā)的幾率有多大，危險因素有哪些？第17頁/共36頁問題3 Although the majority of local recurrences of prostate cancer following radical prostatectomy (RP) are associated with positive surgical margins, a subset of patients with negative surgical margins will develop a local

13、 recurrence.1064 PREDICTORS OF LOCAL RECURRENCE OF PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY WITH NEGATIVE SURGICAL MARGINS第18頁/共36頁問題3 A Total of 8078 patients were identified with negative surgical margins at the time of RP. Median age and BMI at the time of RP were 63 years and 27.5, respec

14、tively. Median preoperative PSA was 5.9. Of these patients, a confirmed local recurrence was noted in 335/8078 (4.1%). On multivariable analysis increased Gleason score noted on preoperative biopsy (p = 0.0053) and tumor volume (p = 0.0003) were significantly associated with local recurrence despite

15、 negative surgical margins.第19頁/共36頁問題4 彈性超聲成像對前列腺癌檢測的結(jié)果如何？第20頁/共36頁問題4 To evaluate whether transrectal sonoelastography (SE) improves visualization of prostate cancer (PCa) in comparison with transrectal grayscale ultrasound (GSU) in patients with biopsy proven PCa.134 PREOPERATIVE PROSTATE CANCER

16、ASSESSMENT: COMPARISON OF THE LATEST GENERATION OF TRANSRECTAL SONOELASTOGRAPHY AND MODERN GRAYSCALE ULTRASOUND WITH WHOLE MOUNT SECTIONS AFTER RADICAL PROSTATECTOMY第21頁/共36頁問題4 Between August 2008 and July 2009 229 patients with biopsy proven PCa underwent preoperative SE with the latest sonoelasto

17、graphic device (Hitachi, EUB-7500HV).第22頁/共36頁問題4 The prostate was divided into 6 areas (base,mid, apex for each side, n=1374) and subsequently screened for cancer suspicious areas. This was postulated for hypoechoic lesions during GSU and stiffer blue-colored lesions according to SE,respectively.第2

18、3頁/共36頁問題4 Sensitivity and specificity were 51% and 72% for SE and 18% and 90% for GSU. Extracapsular extension was identified with a sensitivity and specificity of 38% and 96% using SE compared to 15% and 97% using GSU. Imaging of extracapsular extension and locating prostate cancer lesions were si

19、gnificantly better using SE in comparison to GSU (p20 ng/ml or cT3-4 or biopsy Gleason 8-10) treated with RP and pelvic LND at 7 tertiary referral centers between 1987 and 2009.第28頁/共36頁問題5 Cancer-specific survival（CSS）significantly better in patients with specimen confined disease compared to those

20、 without (10-year CSS 97.4% vs 82.5%, p0.0001). Patients with specimen confined disease were also dramatically less likely to receive adjuvant RT (5.8 vs. 31.4%, p0.0001) and HT (16.2 vs. 64.1%, p0.0001). Outcome of patients with High risk prostate cancer is not invariably poor.第29頁/共36頁問題6 吸煙與前列腺癌的

21、復(fù)發(fā)率是否有關(guān)系？ Among patients undergoing radical prostatectomy in SEARCH, cigarette smoking was associated with slightly more advanced disease but similar risk for biochemical recurrence（289）.第30頁/共36頁問題7 前列腺癌根治術(shù)后10年，如果沒有生化復(fù)發(fā)，我們是否可以停止PSA的檢測？ The majority of biochemical recurrence occurs within 10 years o

22、f surgery. Patients who remain free from progression at 10 years postoperatively should be counseled that their risk of subsequent cancerrelated morbidity and mortality is low（290）.第31頁/共36頁問題8 前列腺癌近距離照射治療對性功能的影響？ After prostate brachytherapy,81.3% and 90% of sexually active men conserved ejaculation and