2013年10月2日 星期三

攝護腺癌

Prostate cancer
 
68, black M, c/o dysuria, progressively↑ed urinary freq, back pain x ms. High animal fat intake.
PE: (digital) nodular, (rock-hard, irregular area of induration in periph lobe of prostate).
Midline furrow b/t prostatic lobes obscured不明. Extension to seminal vesicle detected.
Markedly↑PSA & acid phosphatase.
Transrectal US-prostate : Hypoechoic masses in periph zone w/ extension to seminal vesicles.
Nuc-Bone scan: hot lesions of spine, sacrum, & pelvic bones (axial skeleton).
CT/MR: prostate mass w/ capsular penetration & enlarged seminal vesicles.
Bx : (irregular enlarged, firm, nodular) Core Needle Bx-prostate : single layer of malig cell arranged haphazardly in adenoplastic stroma. 
 
(1malig com arising fr periph zone (70%), mc male cancer.) Px & Tx depend heavily on stage.
Exhibit hematogenous spread: Mc to bone (osteoblastic lesion (bone forming), may also to sacral nerve roots (signif pain))
 
Tx:
Prostatectomy w/ radiation; Orchiectomy;
Leuprolide; androgens; flutamide

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