 |
| 三聯網無機械臂病人需跨區治癌 |
連先生四十多歲，無任何病徵，兩年前陪朋友檢查身體，抽血發現簡稱PSA的前列腺特異抗原指數過高，之後確診前列腺癌。65歲以下前列腺癌個案，5年間多了一倍，每年接近300宗。整體每年新症約1500宗。透過外科手術，可以根治早期前列腺癌。當中使用機械臂，較傳統開刀手術，療效更好。
用機械臂切除前列腺，病人流血大大減少，由於手術更精確，可保留旁邊血管及神經線，病人的勃起功能有機會不影響。
但全港公立醫院，只有瑪麗、威爾斯、瑪嘉烈及東區醫院有機械臂，即是七個聯網當中，三個都沒有這手術。為幫助多些前列腺癌病人，醫管局正推行合作計劃，讓病人跨區轉院用機械臂，廣華、伊利沙伯及屯門醫院也有類似安排。
copy from:
Prostate Cancer
The prostate is a walnut-sized gland that makes and stores seminal fluid, a milky liquid that nourishes sperm. Located below the bladder and in front of the rectum, the prostate encircles the upper part of the urethra, the tube that empties urine from the bladder. The gland helps regulate both bladder control and normal sexual functioning.
Risk factors
Risk factors are traits that increase the likelihood that an individual will develop cancer. They can include diet, inherited (genetic) traits, and exposure to cancer-causing agents in the environment.
· Race
Any man can develop prostate cancer, but for reasons that are not clearly understood, African-American men are twice as likely as white men to develop prostate cancer. Incidence rates are lower among Asian and American Indian men.
· Age
A man's risk of developing prostate cancer increases with age. The disease can occur at any age, but it is most often found in men older than 50, and more than 75 percent of tumors are found in men over age 65.
· Family History
A family history of prostate cancer may also increase a man's risk of developing the disease, particularly if he has a number of close relatives who were diagnosed with prostate cancer or if any relatives were younger than 60 at the time of diagnosis. Such inherited predispositions might be responsible for about 5 to 10 percent of all prostate cancers, according to recent genetic studies.
· Diet
Studies also suggest that a high-fat diet may increase the risk of prostate cancer, and that a diet rich in vegetables, particularly cruciferous vegetables (broccoli, cabbage, cauliflower, kale, collard and mustard greens, horseradish, kohlrabi, brussels sprouts, broccoli rabe, radishes, turnips, and watercress) is associated with a reduced risk of prostate cancer.
· Increasing Incidence
The incidence of prostate cancer has nearly doubled over the past 20 years. This may possibly be due to the fact that deaths from heart disease have declined in recent decades, meaning more men are living longer, into the decades when prostate cancer risk is highest.
· Race
Any man can develop prostate cancer, but for reasons that are not clearly understood, African-American men are twice as likely as white men to develop prostate cancer. Incidence rates are lower among Asian and American Indian men.
· Age
A man's risk of developing prostate cancer increases with age. The disease can occur at any age, but it is most often found in men older than 50, and more than 75 percent of tumors are found in men over age 65.
· Family History
A family history of prostate cancer may also increase a man's risk of developing the disease, particularly if he has a number of close relatives who were diagnosed with prostate cancer or if any relatives were younger than 60 at the time of diagnosis. Such inherited predispositions might be responsible for about 5 to 10 percent of all prostate cancers, according to recent genetic studies.
· Diet
Studies also suggest that a high-fat diet may increase the risk of prostate cancer, and that a diet rich in vegetables, particularly cruciferous vegetables (broccoli, cabbage, cauliflower, kale, collard and mustard greens, horseradish, kohlrabi, brussels sprouts, broccoli rabe, radishes, turnips, and watercress) is associated with a reduced risk of prostate cancer.
· Increasing Incidence
The incidence of prostate cancer has nearly doubled over the past 20 years. This may possibly be due to the fact that deaths from heart disease have declined in recent decades, meaning more men are living longer, into the decades when prostate cancer risk is highest.
Symptoms
Many men with prostate cancer experience no symptoms; the first indication that they may have the disease is often an abnormal finding on a routine screening exam. Others may notice one or more of the following symptoms:
- frequent urination (or an inability to urinate)
- trouble starting or holding back urine flow
- frequent pain or stiffness in the lower back, hips, or upper thighs
- painful ejaculation or trouble having an erection
Some of these symptoms could also be a sign of a common, noncancerous condition called benign prostatic hyperplasia (BPH), an enlargement of the prostate gland. It is important to seek medical attention for any of these symptoms to ensure proper diagnosis and treatment.
Diagnosis
Biopsy
If a man's PSA level is elevated and/or his digital rectal exam is abnormal, his physician will likely suggest a biopsy. This is a procedure in which tissue samples are removed from the prostate and then examined by a pathologist. A biopsy can be performed in a urologist's office. Using a transrectal ultrasound (TRUS) probe, a physician can see the prostate and precisely place the biopsy needles to remove tissue from several different spots in the gland. During a standard biopsy, a physician removes a minimum of ten tissue samples. If the results of the biopsy indicate prostate cancer, the physician will gather more information to further characterize the cancer and help determine the most effective course of treatment. In some cases, the physician may perform a second set of prostate biopsies for this purpose.
Gleason Grading System
Physicians characterize the aggressiveness of prostate cancer using the Gleason grading system, which provides an estimate of the cancer's potential to grow and spread to other parts of the body. The pathologist determines the Gleason grade based on how closely the cells of the gland resemble those of a normal prostate. A tumor whose cellular structure is close to normal is unlikely to be aggressively malignant and to spread -- and will be assigned a low combined Gleason score -- whereas a tumor that has little resemblance to a normal prostate is more likely to be aggressive and spread outside the prostate and will receive a high combined Gleason score (greater than or equal to 7). AmMed Cancer Center’s doctors have an exceptional depth of expertise in analyzing prostate samples, and their skill is critical in helping the other members of the prostate care team determine the most effective course of treatment for each patient.
Treatment is usually recommended for high-grade cancers, while observation may be recommended for low-grade cancers, especially when the patient is elderly or has other medical conditions.
Diagnostic Imaging
Physicians may also perform various imaging tests to determine the extent of the tumor in the prostate and whether cancer cells have spread to surrounding tissues or other parts of the body. Depending on the findings of the DRE, PSA level, biopsy, and Gleason score, these tests may include:
- MRI using an endorectal or surface coil to help assess the extent of the tumor in the prostate and surrounding tissues
- CT scans or radionuclide bone scans to see if the disease has spread to lymph nodes, organs, or bones
- PET, a technique under investigation at Memorial Sloan-Kettering, to assess the extent of prostate cancer and particular features of its biology, such as whether it is responsive to hormonal therapy
In some cases, no scans are necessary because the chance that cancer has spread is very low.
Treatment for the Five Clinical States of Prostate Cancer
1. No Cancer Diagnosis: Prevention & High-Risk Screening
Some men may not have a diagnosis of prostate cancer, but because they have an elevated or rising PSA or a family history of the disease, they are at higher risk of developing the disease. Men in this state are closely watched and undergo regular digital rectal examinations and PSA testing.
AmMed Cancer Center is one of the few cancer centers that offers a assisted family history analysis. Our c counselors can help men whose family histories suggest an increased risk of hereditary prostate cancer, as well as their family members, to further evaluate their risk.
2. Localized Disease
As a result of widespread PSA testing, men whose prostate cancer is seemingly confined to the prostate now make up the largest group of prostate cancer patients, and their disease may be curable with therapy directed solely at the prostate. Physicians here carefully assess the patient's disease and stratify his risk to determine the best treatment choice. Treatment ranges from watchful waiting (deferred therapy) to radiation or surgery alone. For patients with localized disease who are unlikely to be cured with these approaches, we offer multimodality therapy combining hormonal and/or systemic therapy and radiation. Researchers here are also beginning to use new combinations for patients with high-risk disease, including chemotherapy with either hormonal therapy, radiation therapy, or surgery in patients whose cancers do not appear to have spread, but who, judging by various test results, have a poor prognosis with radiation therapy or surgery alone.
3. Rising PSA after Primary Therapy
Men whose PSA levels rise after treatment comprise the second largest segment of the prostate cancer population. For these patients, therapy is directed toward preventing the disease from progressing to the point that it is detectable on a scan or by physical examination or from becoming symptomatic.
Patients with rising PSAs have unique clinical needs. A rising PSA may be the first indication that their disease has spread outside the prostate, but the increase in prostate antigen level is the only sign of disease activity. As yet there is no standard of care for men in this group, but researchers here at MSKCC are at the forefront of efforts to define which type or combination of treatments are likely to be most effective for these patients. And we offer patients in this group a range of clinical trials of new approaches, from vaccine therapy to hormonal therapy to biologic treatments.
Therapeutic approaches for men with rising PSAs may also include observation alone or further treatments to the prostate or the prostate bed. Some patients in this group who have undergone prostatectomy will benefit from further radiation therapy and some who have received radiation therapy will benefit from salvage surgery, while others will require systemic treatment. Our team is expert at determining who will benefit most from which approach and has defined optimal care for these patients.
A recent study, conducted in part at Memorial Sloan-Kettering, suggests that radiation therapy may potentially cure patients whose cancer recurs after prostatectomy. Previous studies suggested that this approach is ineffective, but through this study researchers showed external radiation therapy eradicated residual disease in almost 80 percent of selected patients, with minimal long-term side effects. Our surgeons are also experienced in removing the prostate after other treatments, such as cryotherapy or radioactive seed implants, have failed.
4. Metastatic Disease before Testosterone-Reducing Therapy
Physicians here consider a variety of treatment options for men in this group, which includes those who are diagnosed with metastatic disease (cancer that has spread from the prostate to other sites) and whose testosterone levels are normal. Most patients in this group will receive hormonal therapy, which is not curative but can slow the progress of the disease. We are developing alternative, promising ways to deliver hormonal therapy, such as through rapidly cycling delivery, to overcome the survival mechanisms of cancer cells. We are also looking into novel ways to incorporate chemotherapy or to harness the immune system to enhance the effects of hormonal therapy. Our medical oncologists and basic scientists have a number of collaborative research efforts under way to improve the outlook for this group of patients.
5. Metastatic Disease after Testosterone-Reducing Therapy
Men whose tumors continue to spread after therapy to lower the level of testosterone in the blood have tumors that differ on a molecular level from other metastatic prostate tumors.
Treatments for this group of patients can include additional hormonal therapies, chemotherapy, or, for those who are eligible, investigational approaches available through clinical trials. Treatments are tailored to the individual based on the aggressiveness of his cancer and the predicted molecular profile of his disease. Standard therapies for patients with metastatic disease who do not respond to hormonal treatments are not curative but are designed to slow progression of the disease.
Patients in this state are likely to experience side effects and symptoms from metastatic disease. A team of medical oncologists, psychiatrists, pain and palliative care specialists, surgeons, and radiation oncologists work together to treat the physical and psychological effects of disease among these patients.
Complications of metastatic disease are often related to bone metastases. Medical oncologists can protect bones from disease and from the effects of hormonal therapies.
1. No Cancer Diagnosis: Prevention & High-Risk Screening
Some men may not have a diagnosis of prostate cancer, but because they have an elevated or rising PSA or a family history of the disease, they are at higher risk of developing the disease. Men in this state are closely watched and undergo regular digital rectal examinations and PSA testing.
AmMed Cancer Center is one of the few cancer centers that offers a assisted family history analysis. Our c counselors can help men whose family histories suggest an increased risk of hereditary prostate cancer, as well as their family members, to further evaluate their risk.
2. Localized Disease
As a result of widespread PSA testing, men whose prostate cancer is seemingly confined to the prostate now make up the largest group of prostate cancer patients, and their disease may be curable with therapy directed solely at the prostate. Physicians here carefully assess the patient's disease and stratify his risk to determine the best treatment choice. Treatment ranges from watchful waiting (deferred therapy) to radiation or surgery alone. For patients with localized disease who are unlikely to be cured with these approaches, we offer multimodality therapy combining hormonal and/or systemic therapy and radiation. Researchers here are also beginning to use new combinations for patients with high-risk disease, including chemotherapy with either hormonal therapy, radiation therapy, or surgery in patients whose cancers do not appear to have spread, but who, judging by various test results, have a poor prognosis with radiation therapy or surgery alone.
3. Rising PSA after Primary Therapy
Men whose PSA levels rise after treatment comprise the second largest segment of the prostate cancer population. For these patients, therapy is directed toward preventing the disease from progressing to the point that it is detectable on a scan or by physical examination or from becoming symptomatic.
Patients with rising PSAs have unique clinical needs. A rising PSA may be the first indication that their disease has spread outside the prostate, but the increase in prostate antigen level is the only sign of disease activity. As yet there is no standard of care for men in this group, but researchers here at MSKCC are at the forefront of efforts to define which type or combination of treatments are likely to be most effective for these patients. And we offer patients in this group a range of clinical trials of new approaches, from vaccine therapy to hormonal therapy to biologic treatments.
Therapeutic approaches for men with rising PSAs may also include observation alone or further treatments to the prostate or the prostate bed. Some patients in this group who have undergone prostatectomy will benefit from further radiation therapy and some who have received radiation therapy will benefit from salvage surgery, while others will require systemic treatment. Our team is expert at determining who will benefit most from which approach and has defined optimal care for these patients.
A recent study, conducted in part at Memorial Sloan-Kettering, suggests that radiation therapy may potentially cure patients whose cancer recurs after prostatectomy. Previous studies suggested that this approach is ineffective, but through this study researchers showed external radiation therapy eradicated residual disease in almost 80 percent of selected patients, with minimal long-term side effects. Our surgeons are also experienced in removing the prostate after other treatments, such as cryotherapy or radioactive seed implants, have failed.
4. Metastatic Disease before Testosterone-Reducing Therapy
Physicians here consider a variety of treatment options for men in this group, which includes those who are diagnosed with metastatic disease (cancer that has spread from the prostate to other sites) and whose testosterone levels are normal. Most patients in this group will receive hormonal therapy, which is not curative but can slow the progress of the disease. We are developing alternative, promising ways to deliver hormonal therapy, such as through rapidly cycling delivery, to overcome the survival mechanisms of cancer cells. We are also looking into novel ways to incorporate chemotherapy or to harness the immune system to enhance the effects of hormonal therapy. Our medical oncologists and basic scientists have a number of collaborative research efforts under way to improve the outlook for this group of patients.
5. Metastatic Disease after Testosterone-Reducing Therapy
Men whose tumors continue to spread after therapy to lower the level of testosterone in the blood have tumors that differ on a molecular level from other metastatic prostate tumors.
Treatments for this group of patients can include additional hormonal therapies, chemotherapy, or, for those who are eligible, investigational approaches available through clinical trials. Treatments are tailored to the individual based on the aggressiveness of his cancer and the predicted molecular profile of his disease. Standard therapies for patients with metastatic disease who do not respond to hormonal treatments are not curative but are designed to slow progression of the disease.
Patients in this state are likely to experience side effects and symptoms from metastatic disease. A team of medical oncologists, psychiatrists, pain and palliative care specialists, surgeons, and radiation oncologists work together to treat the physical and psychological effects of disease among these patients.
Complications of metastatic disease are often related to bone metastases. Medical oncologists can protect bones from disease and from the effects of hormonal therapies.
沒有留言:
張貼留言