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臨床攝護腺特異抗原(PSA)檢查應用及攝護腺疾病在中西醫學結合探討
An Investigation of the Integrative Chinese-Western Medicine Approach to Prostate Disease and the Clinical Use of Prostate-Specific Antigen
摘要
在台灣近幾年來攝護腺癌似乎有逐年增加之趨勢，並且其發生的年齢也有逐漸年輕化之傾向，另有文献報告顯示：攝護腺惡性腫瘤不再是老年男性的專有疾病，己經成為台灣地區中壯年男人不可忽視的隱形殺手，在台灣攝護腺癌最主要的問題是診斷時許多都已是晚期攝護腺癌，國人對攝護腺癌的認知不夠普及所造成的，可是國內男性民眾對此疾病的認知及警覺性似乎稍嫌不足。由於，國人攝護腺癌的發生率與死亡率均呈現逐年增加的情形，因此，在台灣中西醫界對攝護腺癌的診療方面，還有很大的空間等待大家共同努力。診斷攝護腺疾病最方便的監測方法就是用PSA檢查；PSA正常參考值是小於4 ng/ml時，PSA若4-10 ng/ml，罹患攝護腺癌的機率為25%。若PSA＞10 ng/ml，罹患攝護腺癌的機率為高過50％（如表一）。不過因為BPH、攝護腺炎等很多情況也會導致PSA值升高。有潛在性罹癌風險者建議50歲以上男性業經告知決定後，如果PSA值在2.5 ng/ml或以上，每年接受例行肛門指診、PSA檢查；如果PSA值低於2.5 ng/ml，則可延長至每二年做一次檢查。但是家族中有攝護腺癌病例者，應該提早自45歲開始進行每年一次的檢查。如果是更高風險族群（如父親和兄弟多位曾或正有攝護腺癌），則應提早至40歲就開始進行血中PSA值檢查。為了提高攝護腺癌的準確率，不單單只是檢驗PSA，更需要多方法來評估，例如：年齡、家族史、% free PSA、PSA值每年增加速率、肛門指檢、經直揚超音波及切片檢查等。初步罹癌於治療前需先做臨床分期(ClinicStage)時，依病情再使用高階影像(CT、MRI、PET)或骨掃描檢查。應用於攝護腺癌PSA值的檢查應該在接受攝護腺根除性手術後或局部完整的放射線治療(RT)後其指數應恢復正常，若是未能恢復正常而其PSA≧0.2 ng/ml時，則表示病人身體內仍有復發或殘存的癌細胞存在。根除性手術後追蹤期或放射治療中，若PSA值又持續升高則通常表示腫瘤復發或治療效果不佳，病患在放射治療後，若PSA值升高超過治療後的最低點2.0 ng/ml，則應視為癌轉移、復發或有殘存性癌細胞。因此，PSA值的檢查可以有效協助攝護腺癌手術根除後復發、轉移或療效評估及觀察病程進展(Progession)的最有效預測因子。
並列摘要
Over recent years in Taiwan the prevalence of prostate disease is on the upward trend with concurrent lowering of the age of onset. Additionally there have been reports that prostate cancer is no longer exclusive to elderly males, that in middle aged healthy men in Taiwan it has become a silent killer which can no longer be ignored. The major issue in Taiwan is that at time of diagnosis the cancer is often already advanced to late stage disease. This is due to a lack of universal awareness among Chinese people and seemingly inadequate levels of awareness and alertness among Taiwanese men. As the frequency and mortality rate of prostate cancer among Chinese people is on the rise there is a lot of room for the combined efforts of Western and Chinese medicine with regards to diagnosis and treatment in Taiwan. In diagnosing prostate cancer the most convenient monitor is the PSA-test; normal range is less than 4ng/ml, if PSA measures between 4-10 ng/ml there is a 25% chance of prostate cancer. If PSA measures over 10ng/ml there is a 50% chance of prostate cancer. Though PSA elevation can also be due to benign prostate hyperplasia or prostatitis. Routine rectal examination and PSA test annually is recommended for men over the age of 50 with PSA levels above 2.5 ng/ml. If PSA levels are below 2.5 ng/ml examination can be performed every two years. Though for patients with a family history of prostate cancer annual checks should begin at age 45. For those in the highest risk group (multiple direct family member occurrence or current prostate cancer) PSA checks should begin at age 40. In order to increase accuracy of diagnosing prostate cancer, in addition to PSA test other methods should be used in evaluation, these include the following: age, family history, % free PSA, annual rate of increase of PSA, digital rectal exam, ultrasound, biopsy, and so on. PSA values should also be observed in follow up after radical prostatectomy or completed local radiotherapy. PSA levels should return to normal, if they remain at PSA≥0.2 ng/ml than this indicates that there are still some remaining cancerous cells in the patient's body. Following a radical prostatectomy while during radiation therapy if the PSA levels continue to climb this often indicates a relapse or poor treatment outcome. If after radiotherapy is complete and the PSA levels climb above 0.2 ng/ml this may indicate metastasis, relapse, or remnants of the cancer cells. Thus PSA is the most effective predictor of metastasis or recurrence, or as a measure of treatment success and disease progression in follow up to radical prostatectomy.