學術論壇
學術論壇可提供瀏覽者及一般會員閱讀瀏覽學術文章。
您必須為協會會員或專科醫師才可擁有發表文章及討論之權限。
您必須為協會會員或專科醫師才可擁有發表文章及討論之權限。
| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 姜秉均 | 前列腺癌根除手術可以改善及避免隨著年紀惡化的下泌尿路障礙 | 2014/2/26 下午 05:11:27 | 0 |
| 原 文 | 題 目 | Radical Prostatectomy Improves and Prevents Age Dependent Progression of Lower Urinary Tract Symptoms |
| 作 者 | Vinay Prabhu, Glen B. Taksler, Ganesh Sivarajan, Juliana Laze, Danil V. Makarov and Herbert Lepor | |
| 出 處 | Journal of Urology | |
| 出版日期 | 2014 Feb | |
| 評 論 | 男性隨著年紀越大，攝護腺肥大引起排尿障礙的比例越高，自五十歲之後，許多男人開始有排尿障礙而尋求醫師的幫助，對醫療支出以及個人生活品質上有很大的衝擊；而台灣的攝護腺癌患者在近幾年有增加的趨勢，根據衛生署的統計資料，於民國99年其發生率已達男性癌症第五位，男性癌症十大死因第七位。攝護腺癌的發生率與年紀有關，越年長罹患機率越高，初期攝護腺癌治療方式包括攝護腺癌根除手術、腹腔鏡攝護腺根除手術、機器人手臂輔助攝護腺癌、冷凍治療(氬氦刀)、海福刀治療、放射線治療等，此篇研究追蹤了1788個罹患攝護腺癌而接受攝護腺癌根除手術的患者(皆由單一術者完成)，對其排尿症狀(AUASS or IPSS)從術前、術後3、6、12、24、48、60、84、96個月、一直到第10年，發現術前具有中度及重度排尿障礙的患者(AUASS>7)，於術後三個月至四年內的時間，其排尿症狀會逐漸較術前改善，其後症狀趨於穩定，追蹤到第十年，AUASS自起始的平均13.5下降至8.81 (p<0.001)；術前只有輕度排尿障礙的患者(AUASS≦7)，於術後三個月的症狀達到高峰，其後症狀緩慢改善一直到滿二年開始趨於穩定，追蹤到第十年，AUASS自起始的平均3.09些許上升至4.94(p<0.01)，雖然此篇文章並無清楚的將患者的藥物使用狀況做詳細的分析，但是其患者數量足以代表攝護腺癌經攝護腺根除術術後的患者長期追蹤的狀況，證實攝護腺根除術為目前唯一長期追蹤下能夠改善及預防隨著年紀越大產生的排尿障礙，特別是在術前已經有中度或重度排尿障礙的病人。 | |
| abstract |
Purpose: The prevalence of lower urinary tract symptoms increases with age and impairs quality of life. Radical prostatectomy has been shown to relieve lower urinary tract symptoms at short-term followup but the long-term effect of radical prostatectomy on lower urinary tract symptoms is unclear. Materials and Methods: We performed a prospective cohort study of 1,788 men undergoing radical prostatectomy. The progression of scores from the selfadministered AUASS (American Urological Association symptom score) preoperatively, and at 3, 6, 12, 24, 48, 60, 84, 96 and 120 months was analyzed using models controlling for preoperative AUASS, age, prostate specific antigen, pathological Gleason score and stage, nerve sparing, race and marital status. This model was also applied to patients stratified by baseline clinically significant (AUASS greater than 7) and insignificant (AUASS 7 or less) lower urinary tract symptoms. Results: Men exhibited an immediate worsening of lower urinary tract symptoms that improved between 3 months and 2 years after radical prostatectomy. Overall the difference between mean AUASS at baseline and at 10 years was not statistically or clinically significant. Men with baseline clinically significant lower urinary tract symptoms experienced immediate improvements in lower urinary tract symptoms that lasted until 10 years after radical prostatectomy (13.5 vs 8.81, p <0.001). Men with baseline clinically insignificant lower urinary tract symptoms experienced a statistically significant but clinically insignificant increase in mean AUASS after 10 years (3.09 to 4.94, p <0.001). The percentage of men with clinically significant lower urinary tract symptoms decreased from baseline to 10 years after radical prostatectomy (p < 0.02). Conclusions: Radical prostatectomy is the only treatment for prostate cancer shown to improve and prevent the development of lower urinary tract symptoms at long-term followup. This previously unrecognized long-term benefit argues in favor of the prostate as the primary contributor to male lower urinary tract symptoms. |
|
| 回覆發表 | 回覆討論主題內容 | 最後發表 |
| 目前尚無任何相關的回覆資料 | ||