What is prostate cancer
First of all, the prostate is under the bladder, shaped like the pointed one of chestnut faces towards the penis, and the urethra is lodged in the interior leading to the urethra in the penis. The function of the prostate secretes the liquid component of semen and helps sperm movement.
1
The prostate is an organ only in men, it does not exist in women. It is embryologically equivalent to a woman's uterus. Cancer that occurs in this prostate is called prostate cancer.
Epidemiology
I will show male cancer incidence in Japan and future prospects.
2
I can see that prostate cancer has increased markedly. In 2020, it is estimated that it will be the second largest affected number after lung cancer. The background of the increase is related to the fact that as society ages, the dietary habits become westernized, and the diagnosis technology advances, many things have come to be discovered.
I will show you the incidence of prostate cancer by age.
It turns out that prostate cancer is a typical elderly cancer that increases with age.
Diagnosis
As a test and diagnosis of prostate cancer, we conduct tumor marker, PSA examination, rectal examination, ultrasound examination by blood test as examination to find a person with cancer possibility. If you suspect cancer here, you will do a prostate biopsy and tissue examination to confirm cancer, but before you undergo a biopsy to see where in the prostate cancer is likely to occur, a tomogram called MRI I will take. When cancer is confirmed, we will examine bone metastasis called CT tomography and bone scintigraphy to investigate the spread of cancer.
3
PSA test is a convenient method of finding prostate cancer by blood test. "Prostate" "Unique" "Antigen" English initial letters were attached. PSA is a type of protein made in the prostate and exists in the blood even when it is healthy but it is used as a tumor marker for prostate cancer because a large amount of PSA flows out into the blood when prostate cancer develops It began.
4.
The relationship between PSA value and prostate cancer detection rate, the higher the PSA value, the higher the likelihood of prostate cancer. If the PSA value is higher than 4, prostate cancer is suspected, 10 in 1/3 and 1/20 in half, and in more than 50 in prostate cancer is found in most people. Also, the possibility of metastasis will also come if you get 50 or more.
5.
If prostate cancer is suspected, a tissue examination called prostate biopsy will be conducted, but under anesthesia, ultrasound is inserted from the anus, a fine needle is stabbed while observing the image, about 10 prostate tissues are collected To do. Then examine with a microscope for cancer. Because I do anesthesia, there is hardly any pain.
6
Although it is an image examination, in MRI, it is investigated whether there is spread to the cancer place and surroundings, in CT, whether the lymph nodes and other organs have metastasis.
7
Bone scintigraph examines the presence or absence of bone metastasis. The place where the transition exists is blackened. With X-rays, the place where the transition exists is whiter than other places.
8
Treatment
Treatment for prostate cancer can be broadly divided into treatment to the whole body and treatment to the prostate. There is hormonal therapy for the treatment of the whole body, but there are treatments of medication treatment and removal of the testicles. Treatment for the prostate, the surgical treatment will remove all the prostate. As radiation treatment, there are methods of irradiating from outside the body and irradiation from the inside of the body.
9
Hormonal therapy
Male hormones promote proliferation of cancer cells in the prostate. Hormonal therapy is the reverse of this. Prostate cancer growth is suppressed and the cancer is reduced as a result of removing the testicles or by taking medicine to prevent the transition of the nutritional source, androgen, to prostate cancer. In medicine, there are drinking drugs that suppress the actions of male hormones, and injection medicines that suppress the secretion of male hormones. If the effect of hormonal therapy is lost, treatment of anticancer drugs is necessary.
Surgical treatment
Surgery is called total prostatectomy. Laparotomy was a standard procedure in the operation to remove the seminal vesicle attached with the prostate, and gradually moved to laparoscopic surgery
10
Laparoscopic surgery is a surgical operation performed by observing the endoscope image with inflating carbon dioxide and carbon dioxide in the stomach like this. Insert the forceps and the endoscope with the instrument called a trocar as a passage
11
In laparoscopic surgery, the surgeon stands on the patient's left side, assistant, photographer on the right side. Then surgery is performed while watching the monitor on the foot side
12
It is the first advantage of laparoscopic surgery for prostate cancer, but it is not only small and inconspicuous but also has a mild postoperative pain and rehabilitation faster. Although it is surgical wound, laparotomy surgery enters about 20 cm incision in the lower abdomen, but in laparoscopy there are only 5 small scratches from 5 to 12 mm
13
The second advantage is that the pressure due to pneumoperitoneum results in a very small amount of bleeding compared to laparotomy, requiring transfusion is rare. As a third advantage, because of the enlarged visual field through the endoscope, it is expected to improve cancer cancers and postoperative quality of life (urinary incontinence, deterioration of sexual function) by delicate surgery. The probability of resection is the probability of cancer at the end of the resected prostate, but in our hospital it is also lower than laparotomy with laparoscopic surgery, the rate of recurrence is small and laparoscopic surgery is radical It is clear that it is excellent in the ability to cure cancer. As for surgical operation time, it is technically difficult compared to laparotomy surgery, so it is said that surgery is long, but our hospital has no difference from laparotomy with 2 hours to 2 and a half hours (median 2 hours 25 minutes) .
Radiation treatment
It is a treatment method which irradiates radiation and kills cancer cells. Since the burden on the body is less than surgery, treatment is possible for elderly people and people who have heavy medical history. There are two methods of irradiation from the outside of the body and irradiation from inside the body. A therapy that radiates radiation to the prostate from outside the body keeps a mark on the skin and irradiates the radiation there. One irradiation time is 5 minutes, there is no pain due to irradiation. Therefore, even outpatient treatment is possible. Usually, I continue to irradiate 5 days a week once a day for 7 weeks. Inflammation to the place you see is seen as a complication during treatment. If inflammation of the skin or inflammation of the bladder occurs, urination pain and frequent urine are seen, and diarrhea and anal pain are seen when the rectum is inflamed. There is bleeding as a complication of late period for a while after treatment, hematuria and blood stool may be seen. However, due to the progress of instruments, complications are decreasing considerably. Irradiation from the body is a new treatment that embeds the source of radiation inside the prostate and kills cancer cells. Insert the source of radiation while watching with ultrasound. The time is about a few hours. It is a short period, but hospitalization is necessary. If you have cancer at a very early stage, you can expect the same therapeutic effect as surgery.
First of all, the prostate is under the bladder, shaped like the pointed one of chestnut faces towards the penis, and the urethra is lodged in the interior leading to the urethra in the penis. The function of the prostate secretes the liquid component of semen and helps sperm movement.
1
The prostate is an organ only in men, it does not exist in women. It is embryologically equivalent to a woman's uterus. Cancer that occurs in this prostate is called prostate cancer.
Epidemiology
I will show male cancer incidence in Japan and future prospects.
2
I can see that prostate cancer has increased markedly. In 2020, it is estimated that it will be the second largest affected number after lung cancer. The background of the increase is related to the fact that as society ages, the dietary habits become westernized, and the diagnosis technology advances, many things have come to be discovered.
I will show you the incidence of prostate cancer by age.
It turns out that prostate cancer is a typical elderly cancer that increases with age.
Diagnosis
As a test and diagnosis of prostate cancer, we conduct tumor marker, PSA examination, rectal examination, ultrasound examination by blood test as examination to find a person with cancer possibility. If you suspect cancer here, you will do a prostate biopsy and tissue examination to confirm cancer, but before you undergo a biopsy to see where in the prostate cancer is likely to occur, a tomogram called MRI I will take. When cancer is confirmed, we will examine bone metastasis called CT tomography and bone scintigraphy to investigate the spread of cancer.
3
PSA test is a convenient method of finding prostate cancer by blood test. "Prostate" "Unique" "Antigen" English initial letters were attached. PSA is a type of protein made in the prostate and exists in the blood even when it is healthy but it is used as a tumor marker for prostate cancer because a large amount of PSA flows out into the blood when prostate cancer develops It began.
4.
The relationship between PSA value and prostate cancer detection rate, the higher the PSA value, the higher the likelihood of prostate cancer. If the PSA value is higher than 4, prostate cancer is suspected, 10 in 1/3 and 1/20 in half, and in more than 50 in prostate cancer is found in most people. Also, the possibility of metastasis will also come if you get 50 or more.
5.
If prostate cancer is suspected, a tissue examination called prostate biopsy will be conducted, but under anesthesia, ultrasound is inserted from the anus, a fine needle is stabbed while observing the image, about 10 prostate tissues are collected To do. Then examine with a microscope for cancer. Because I do anesthesia, there is hardly any pain.
6
Although it is an image examination, in MRI, it is investigated whether there is spread to the cancer place and surroundings, in CT, whether the lymph nodes and other organs have metastasis.
7
Bone scintigraph examines the presence or absence of bone metastasis. The place where the transition exists is blackened. With X-rays, the place where the transition exists is whiter than other places.
8
Treatment
Treatment for prostate cancer can be broadly divided into treatment to the whole body and treatment to the prostate. There is hormonal therapy for the treatment of the whole body, but there are treatments of medication treatment and removal of the testicles. Treatment for the prostate, the surgical treatment will remove all the prostate. As radiation treatment, there are methods of irradiating from outside the body and irradiation from the inside of the body.
9
Hormonal therapy
Male hormones promote proliferation of cancer cells in the prostate. Hormonal therapy is the reverse of this. Prostate cancer growth is suppressed and the cancer is reduced as a result of removing the testicles or by taking medicine to prevent the transition of the nutritional source, androgen, to prostate cancer. In medicine, there are drinking drugs that suppress the actions of male hormones, and injection medicines that suppress the secretion of male hormones. If the effect of hormonal therapy is lost, treatment of anticancer drugs is necessary.
Surgical treatment
Surgery is called total prostatectomy. Laparotomy was a standard procedure in the operation to remove the seminal vesicle attached with the prostate, and gradually moved to laparoscopic surgery
10
Laparoscopic surgery is a surgical operation performed by observing the endoscope image with inflating carbon dioxide and carbon dioxide in the stomach like this. Insert the forceps and the endoscope with the instrument called a trocar as a passage
11
In laparoscopic surgery, the surgeon stands on the patient's left side, assistant, photographer on the right side. Then surgery is performed while watching the monitor on the foot side
12
It is the first advantage of laparoscopic surgery for prostate cancer, but it is not only small and inconspicuous but also has a mild postoperative pain and rehabilitation faster. Although it is surgical wound, laparotomy surgery enters about 20 cm incision in the lower abdomen, but in laparoscopy there are only 5 small scratches from 5 to 12 mm
13
The second advantage is that the pressure due to pneumoperitoneum results in a very small amount of bleeding compared to laparotomy, requiring transfusion is rare. As a third advantage, because of the enlarged visual field through the endoscope, it is expected to improve cancer cancers and postoperative quality of life (urinary incontinence, deterioration of sexual function) by delicate surgery. The probability of resection is the probability of cancer at the end of the resected prostate, but in our hospital it is also lower than laparotomy with laparoscopic surgery, the rate of recurrence is small and laparoscopic surgery is radical It is clear that it is excellent in the ability to cure cancer. As for surgical operation time, it is technically difficult compared to laparotomy surgery, so it is said that surgery is long, but our hospital has no difference from laparotomy with 2 hours to 2 and a half hours (median 2 hours 25 minutes) .
Radiation treatment
It is a treatment method which irradiates radiation and kills cancer cells. Since the burden on the body is less than surgery, treatment is possible for elderly people and people who have heavy medical history. There are two methods of irradiation from the outside of the body and irradiation from inside the body. A therapy that radiates radiation to the prostate from outside the body keeps a mark on the skin and irradiates the radiation there. One irradiation time is 5 minutes, there is no pain due to irradiation. Therefore, even outpatient treatment is possible. Usually, I continue to irradiate 5 days a week once a day for 7 weeks. Inflammation to the place you see is seen as a complication during treatment. If inflammation of the skin or inflammation of the bladder occurs, urination pain and frequent urine are seen, and diarrhea and anal pain are seen when the rectum is inflamed. There is bleeding as a complication of late period for a while after treatment, hematuria and blood stool may be seen. However, due to the progress of instruments, complications are decreasing considerably. Irradiation from the body is a new treatment that embeds the source of radiation inside the prostate and kills cancer cells. Insert the source of radiation while watching with ultrasound. The time is about a few hours. It is a short period, but hospitalization is necessary. If you have cancer at a very early stage, you can expect the same therapeutic effect as surgery.
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