b*h
发帖数: 637 | 1 我父亲今年61岁。 前列腺增生有几年了，还没有治疗。现在小便频繁，他比较苦恼。
PSA值去年10， 今年还是10. 一个医生建议做前列腺穿刺。我自己看了一下资料说是前
列腺穿刺不推荐。测试的患者往往出现严重的感染，勃起功能障碍和尿失禁。
有些文献说:Prostate cancer tests is more harm than good。
在wikipedia上说，很多老年男性都可能有前列腺癌，但是大多是良性而且增长缓慢。
请懂的人给说说，我父亲的情况有必要现在做前列腺穿刺吗？
还有医生建议做微创手术，我也比较保守。因为微创也是很有损伤的，不一定能治好不
说，做了手术也要靠管子排尿两周。期间可能感染。对患者来说，痛苦还是比较大的。
我个人认为开始吃药控制比较好？ 但是，这样会不会把老爸给耽误了。请懂的人给指
点一二。 |
l*h
发帖数: 4124 | 2 what is his purpose of biopsy? 10ng/ml is not too high even though in the
past some suggested 4 as the cutoff value. now it is agreed that at about
this level, the absolute value is not important. the more important thing is
the trend.
if fear of prostate cancer, proper imaging studies should be done before
considering biopsy.
。
。
【在 b*h 的大作中提到】
: 我父亲今年61岁。 前列腺增生有几年了，还没有治疗。现在小便频繁，他比较苦恼。
: PSA值去年10， 今年还是10. 一个医生建议做前列腺穿刺。我自己看了一下资料说是前
: 列腺穿刺不推荐。测试的患者往往出现严重的感染，勃起功能障碍和尿失禁。
: 有些文献说:Prostate cancer tests is more harm than good。
: 在wikipedia上说，很多老年男性都可能有前列腺癌，但是大多是良性而且增长缓慢。
: 请懂的人给说说，我父亲的情况有必要现在做前列腺穿刺吗？
: 还有医生建议做微创手术，我也比较保守。因为微创也是很有损伤的，不一定能治好不
: 说，做了手术也要靠管子排尿两周。期间可能感染。对患者来说，痛苦还是比较大的。
: 我个人认为开始吃药控制比较好？ 但是，这样会不会把老爸给耽误了。请懂的人给指
: 点一二。
|
b*h
发帖数: 637 | 3 做穿刺的目的是什么我们也很迷惑。所以到这里来问问。 照了影像图，应该是B超成像
吧（老爸说就是拿着一个仪器在前列腺照的）。诊断说是前列腺增生。这次这个医生说
是去年PSA值是10，今年还是10. 然后就建议去穿刺。其实老爸看了几个医生，只有这
个说去做穿刺。现在的主要问题是老爸总是尿急尿频，他很为之苦恼，想着能有办法给
治好了。现在看来这个是不能根治的。做穿刺是不能诊断出什么的是吧。
听了您的建议。我们就更觉得穿刺是没有必要的了。现在决定先吃药控制。我爷爷（老
爸的父亲）以前也是有前列腺增生，后来查出前列腺癌，在83岁的时候做了前列腺癌症
的手术，然后尿血就去世了。所以，我们还是有些担心老爸的。但是，最近看了文献说
老年男性即使最后发展成为前列腺癌其实也不会再有生之年影响生命因为前列腺癌发展
的很慢。
这样看来吃药控制就是比较好的办法了吧。有没有其他的什么能做到。吃中药不知道怎
样。
is
【在 l*h 的大作中提到】
: what is his purpose of biopsy? 10ng/ml is not too high even though in the
: past some suggested 4 as the cutoff value. now it is agreed that at about
: this level, the absolute value is not important. the more important thing is
: the trend.
: if fear of prostate cancer, proper imaging studies should be done before
: considering biopsy.
:
: 。
: 。
|
a**********2
发帖数: 3726 | 4 It is a tough call. There is still no agreement about when people shoudl get
serious workup for prostate cancer. But based on the fact that PSA has been
stably low, I tend not to go further than ultrasound or CT scan.
For his benign prostate hypertrophy, try Flomax (tamsulosin).
Your grandpa was diagnosed with prostate cancer at that age, it does not
mean it will be passed on to your father. FYI, in theory, most males who
live long enough may have prostate cancer, at different stages. Some die of
other diseases with early stage of prostate cancer (which is not the killer
and never found out, and no need to be found out), some may have advanced
stage of prostate cancer, then get treated at that time. |
b*h
发帖数: 637 | 5 太感谢aprilfool002的回复了。
我可不可以这样理解您说的意思（连同lmh的所说的）。对于我老爸来说，现在就是吃
西药包括西红柿素,比如您提到的，Flomax (tamsulosin)来减少症状。但是前列腺还是
会慢慢增大的。然后就是每年去查一查PSA值和做前列腺B超/造影，确定没有发展成为
前列腺癌。退一万步说就是有了前列腺癌，这个癌也是发展缓慢的，一般也不一定缩短
寿命。
其实我爷爷也是从60多岁就有冠心病，虽然最后是做了前列腺癌手术之后，术后并发症
去世。但是毕竟是83岁了，所以今天看来也不一定是非要做那个前列腺癌手术的。
另外你说的PSA10 是稳定的低，我才知道原来10是低的呀。老爸在北京301和北医一院
都看过。我们一直以为是高的呢。好像没有医生告诉他现在标准到底是怎么样的。多亏
来这里问问。我们还以为测PSA是为了诊断前列腺增生呢，现在才明白是为了排除前列
腺癌症。原来做穿刺也是为了检查有没有前列腺癌。而前列腺增生本身是很容易确诊的
，只有看看B超和CT再加上这么明显的症状就能确诊了。所以，如果只是要治疗和控制
前列腺增生，其实不再需要做穿刺和PSA test了。老爸现在就是想控制尿频，尿急。所
以就让他吃西药控制着就行了。 |
a**********2
发帖数: 3726 | 6 Tamsulosin is used to treat BPH, it should relieve the symptoms, but not
stop the progression of BPH. It doesn't help prostate cancer caused urinary
retention.
As for annual screening, there is no consensus about that. It's fine to do
yearly PSA. Ultrasound or CT? I don't think it's necessary.
I should not say 10 is low according to current cutoff which is 4. But this
mild elevation can be caused by many things (a marker far from specific),
BPH is one of them. Especially both last year and this year it was 10, not
trending up, it doesn't look to me a prostate cancer. But I have to
emphasize that the diagnosis of prostate cancer is complicated, PSA is
definitely unreliable. So I can't guranttee, it's just a low probability to
me.
And yes, prostate cancer usually progresses very slowly. Many people have
silent prostate cancer and die of something else (aging related). Some may
have advanced disease as initial presentation like bone metastasis. So, it's
really hard to say. But again, based on what you said, I highly doubt it is
prostate cancer. But I could be wrong. |
a**********2
发帖数: 3726 | 7 For your grandfather, definitely the surgery was not necessary for his age.
Many doctors may still recommend surgery, I don't. I am very conservative
when I give medical advice to my family members since I definitely will
weigh the risks and benefits. But to patients, I will not discourage them in
order to avoid unnecessary troubles.
Prostate cancer surgery has too many complications, plus adjuvant therapy
simply lower the quality of life for a 80s or 90s. If that happened to my
family member who is at the age of 80s, I would recommend only medical
treatment (anti hormone therapy). The only concern is metastasis if not
surgically resected. That's another topic, will more more complicated. |
b*h
发帖数: 637 | 8 明白，明白。要是真正确诊前列腺癌是很复杂的。我今天学到的就是让老爸多多观察，
必要的时候去检查。另外前列腺增生是只能吃药控制的。
现在有前列腺微创手术，有好几种，老爸在北京301医院看的时候，医生说做微创好，
痛苦小。我查了之后，觉得所说的微创是把探头深入前列腺，把多余的组织烧掉。看到
有网上国内很多病患说术后至少两周都只能插管排尿，还有的感染了。非常痛苦。而且
，有的说术后没有很大的改善。当然可能做了微创好了的，就没再网上说也可能。
我爸因为最近一年尿频，尿急，所以幸事淡淡就想去做了。但是，我很反对。就想着先
吃药控制。不知道前列腺微创手术是利大些还是弊大些。是不是真的有国内医生说的那
么好？ |
a**********2
发帖数: 3726 | 9 I think it makes sense to try medication first, if not controlled well or
progressively get worse, then try surgery. You don't need to jump to surgery
initially especially there are many complications and risks. I am very
conservative in treatment.
【在 b*h 的大作中提到】
: 明白，明白。要是真正确诊前列腺癌是很复杂的。我今天学到的就是让老爸多多观察，
: 必要的时候去检查。另外前列腺增生是只能吃药控制的。
: 现在有前列腺微创手术，有好几种，老爸在北京301医院看的时候，医生说做微创好，
: 痛苦小。我查了之后，觉得所说的微创是把探头深入前列腺，把多余的组织烧掉。看到
: 有网上国内很多病患说术后至少两周都只能插管排尿，还有的感染了。非常痛苦。而且
: ，有的说术后没有很大的改善。当然可能做了微创好了的，就没再网上说也可能。
: 我爸因为最近一年尿频，尿急，所以幸事淡淡就想去做了。但是，我很反对。就想着先
: 吃药控制。不知道前列腺微创手术是利大些还是弊大些。是不是真的有国内医生说的那
: 么好？
|
b*h
发帖数: 637 | 10 2012年最后一天真是学到很多东西。太感谢了！ |
a**********2
发帖数: 3726 | |
a**********2
发帖数: 3726 | 12 Oh btw, take Flomax before going to bed. Watch out orthostatic hypotension
in the first few days, which means when he gets up from bed after taking
medication, get up slowly and sit up for a few minutes before move around. |
b*h
发帖数: 637 | |
