廖炎智1 吳哲豪2 李政育2 王美純3
1.國防醫學院 三軍總醫院 核子醫學部
2.育生中醫診所
3.國防醫學院 三軍總醫院 病歷室
通訊作者：廖炎智、王美純
連絡地址：台北市內湖區成功路2段325號3F 核子醫學部
Tel：02-87923311 # 12602
E-Mail：nmliao2@gmail.com
2014年08月02日受理; 2014年12月14日刊載
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?
也有逐漸年輕化之傾向，另有文?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(Clinic
Stage)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。
關鍵詞：
攝護腺癌 (Prostate cancer) 、攝護腺特定抗原 (Prostate Specific Antigen, PSA)、
游離攝護腺抗原百分比(% free PSA)、攝護腺肥大 (Benign Prostate Hyperplasia,
BPH)
An Investigation of the Integrative Chinese-
Western Medicine Approach to Prostate Disease
and the Clinical Use of Prostate-Specific Antigen
Liao Yan-Chih 1 Wu Che-Hao 2 Lee Chen-Yu 2 Wang mei-Chuen 3
1. National Defense Medical Center, Tri-Service General Hospital Department
of Nuclear Medicine
2. Yu-Sheng Chinese Medical Clinic
3. National Defense Medical Center, Tri-Service General Hospital Department
of Medical Records Department
Authors：Liao Yan-Chih, Wang mei-Chuen
Address：Department of Nuclear Medicine, Cheng-Gong Rd Sec.3 #325,
Neihu District Taipei city, Taiwan, R.O.C
Tel：02-87923311 # 12602
E-Mail：nmliao2@gmail.com
Received：2014.08.02; Accepted：2014.12.14
P. 014~034
Abstract:
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.
Key Words:
Prostate Cancer, Prostate Specific Antigen, PSA, % Free PSA,
Benign Prostate Hyperplasia, BPH