醫學專欄~黃書彬-攝護腺癌的迷失

1. 103
4904
;
!
?
: ?
20 ,
:
?
?
(PSA) :
PSA
(PSA)
2012 US
Preventive Services Task Force (USPSTF)
: PSA ;
PSA
,
!?
?
?

2. :
: 50 ,
, 21%
;
Rullis I 80
67%
?
:
cancer)
; (
<0.5 ) :
(Gleason Score) 6
PSA -
;
? Epstein :
T1C, PSA < 0.15 ng/
ml, 4 5
3
(core) < 50%
Epstein
70% -- 30%
,
4 5,
!
active
surveillance PSA,
,
:
20~35%
8%~ 44%
24%~33%
( )
PSA
?
: PSA
-
: ,

3. - ;
; ;
:
,
(
)
(33%),
(4%)
! ;
( ):
:
5 48%
10 25%!
:
PSA (
100%)
,
PSA
(33%)
;

4. !
( ): A
PSA
:
:
(ADT)
2~3
!
10~ 15
B :
:
)
(
)
( )

5. !
;
: ?

6. (
pT3 );
(
)
-
?
PSA 12
ng/ml,
5-6 PSA 40
PSA 60
ng/ml(
) pT3b
!
PSA
PSA
PSA 4
10ng/ml ( )
18~ 22 %
75%
(repeat biopsy)?
PCA3;
(Prostate Health Index )(phi)
4K Score
( )
(mpMRI)
MRI
( )
!
;
:

7. !
2011
2011
:
– Cabazitaxel
(Zytiga, Abiraterone acetate)
(Xtandi, Enzalutamide) ( -
223 Radium-223)
( )
,
80%
,
!
1.
2. Ploussard G1, Epstein JI, Montironi R, Carroll
PR, Wirth M, Grimm MO, Bjartell AS,
Montorsi F, Freedland SJ, Erbersdobler A, van
der Kwast TH.The contemporary concept of
Eur Urol.2011 Aug;60(2):291-303.
3. American Urological Association (AUA)
Annual Meeting Webcast 2015, 2016; AUA
080PG 059IC course handout 2015; AUA
042IC course handout 2016
4.
5. NCCN Clinical Practice Guidelines in
Oncology ( NCCN Guidelines) Prostate
Cancer 2017