Prostate Cancer: Diagnosis, Imaging, and Robotic Surgery
SKH Yip
Hong Kong J Radiol 2013;16(Suppl):S66-8
Prostate cancer is the third most common cancer affecting men in Hong Kong, and the fifth leading cause of cancer death in Hong Kong males. The diagnosis of prostate cancer is confirmed by biopsy. The cancer detection rate may be enhanced by judicious use of imaging studies and adopting an increased biopsy core protocol, particularly of the far lateral zone. Treatment of localised prostate cancer can range from active surveillance and irradiation to radical prostatectomy, depending on the patient and disease status. In terms of surgical treatment, robot-assisted laparoscopic radical prostatectomy represents one of the latest and most significant advances in minimally invasive surgery. Compared with open prostatectomy, this method is associated with significantly lower transfusion rates, faster patient recovery, and reduced hospital stay. For the surgeon, the advantages of this technique include improved vision and better instrument handling. It allows meticulous dissection of the prostate apex and neurovascular bundle so that sexual function may be preserved. Continence rates can be as high as 90% in patients who undergo this surgical procedure. In experienced hands, a positive surgical margin rate of less than 10% for localised disease can be achieved. Over the long term, robot-assisted laparoscopic radical prostatectomy has been associated with high rates of biochemical control. This article discusses the diagnosis of prostate cancer, with special focus on biopsy and surgical treatment with robot-assisted laparoscopic radical prostatectomy in the management of localised prostate cancer.
中文摘要
前列腺癌：診斷、放射及機械臂輔助手術
葉錦洪
前列腺癌是香港男性中第三大最常見的癌症，亦是香港男性第五大癌病死亡原因。前列腺癌的診斷須通過活組織化驗證實。適當地使用影像檢查及增加活檢組織的數目，尤其在遠外側區抽取組織，有助提高癌症的檢出率。早期前列腺癌的治療視乎病人及疾病狀況，從積極監測、放射治療（電療）、到前列腺癌根治手術不等。手術治療方面，機械臂輔助腹腔鏡前列腺癌根治術是微創手術中最嶄新的突破之一，與開放性前列腺切除手術相比，輸血率顯著降低、病人恢復較快、且住院時間較短。對外科醫生來說，這項技術的優點包括改善視野及儀器操控，從而可令切割前列腺尖部及神經血管束等重要部位時更細緻，以幫助保存性功能；接受這項手術的病人中，排尿控制率可高達90%。對於早期癌症，手術若由富經驗的外科團隊進行，可達到小於10%的手術切緣陽性率。機械臂輔助腹腔鏡前列腺癌根治術已證明有高效的癌病控制。本文討論了前列腺癌的診斷，並重點探討活組織化驗及機械臂輔助腹腔鏡前列腺癌根治術，在治療早期前列腺癌中的應用。