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\u7de8\u8f2f\uff1a\u6881\u5c0f\u73b2<\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】編按﹕患上癌症，一直以來的治療方向是﹕第一時間用刀用電用毒殲滅所有癌細胞。但近年研究發現，前列腺癌發展緩慢，低風險的前列腺癌病人，不接受任何治療，與接受手術或電療的病人作比較，十年存活率相若。是否意味着「唔醫好過醫」？<\/p>\n

腫瘤生長較慢 或多年未被發現<\/p>\n

很多男士會問﹕「良性前列腺增生問題很常見，那患有前列腺癌的風險豈不是十分大？」的確，年過三十的男士，前列腺結構上會有改變而引發良性前列腺增生；但不代表一定與前列腺癌掛鈎，只有當細胞出現基因變異才會成為惡性腫瘤，亦即前列腺癌。可是，大部分前列腺癌的生長發展較緩慢，腫瘤可存在多年也未被發現。正因如此，及早發現可跟醫生商討並制定最合適的治療方案。<\/p>\n

2016年10月，《新英倫醫學期刊》發表了英國一項為期十年的研究報告。有研究中心於1999至2009年期間，為約8.2萬名年齡介乎50至69歲的男性進行「前列腺特異抗原（PSA）測試」，發現內裏有二千多人確診患有早期低風險前列腺癌。1643名病人之後選擇加入這項研究，當中545人積極監察（不採取任何積極治療方案，只接受緊密監察）、553人選擇接受前列腺切除手術、545人則選擇俗稱電療的放射治療。該研究中心發現，十年後，三個方案的存活率相若（見表）。<\/p>\n

研究﹕接受治療 腫瘤擴散人數較少<\/p>\n

那麼，前列腺癌病人是否「什麼也不做」會更好？畢竟電療和手術都會帶來一定的風險和副作用，或會影響生活質素。但是，研究報告亦同時顯示，在545名積極監察的病人中，有33人有腫瘤擴散迹象；接受了手術的病人中，則只有13人有腫瘤擴散迹象。而發現有病情發展的人數，在積極監察那組別亦相對較高。<\/p>\n

由此可見，儘管十年後的存活率相若，但不代表15、20年後的存活率也一樣。而且病情有可能隨時間惡化，所以病人應該跟醫生商量，再因應自己的實際病情選擇合適的治療方案，而非認為只接受積極監察便行。<\/p>\n

與任何慢性疾病一樣，前列腺癌的治療目的也是為了延長壽命。醫生一般會根據病人的身體狀况、期望、家族史，甚至其父母的壽命，作為制定治療方案的考量。如78歲的病人沒有其他健康問題而父母的壽命亦較長的話，仍然可以考慮較積極的治療方案；相反，若65歲的病人同時有多種其他嚴重慢性疾病，便可能需要接受較保守的治療。<\/p>\n

切前列腺仍可保性功能<\/p>\n

面對高風險或中期的前列腺癌病人，過往多會採用電療和荷爾蒙藥物治療，但最近亦有研究顯示，切除手術配合其他輔助治療的存活率較電療高。故手術切除治療這方案在這批病人已較多被選擇採用。雖然前列腺切除手術在不少案例是「一了百了」的治療方案，但即使是微創手術，也有可能出現失禁或勃起功能障礙的問題；加上前列腺癌大多發生於年紀較大的男士當中，不是每名病人也適合進取的治療方案。對於癌症晚期的病人來說，更是不適用。<\/p>\n

曾經有個年約50的男病人，出現尿頻的現象已有一段時間，但礙於面子問題而一直不肯就醫，最後因半夜不斷起牀小便，影響夫妻二人的睡眠質素，在妻子的要求和陪同下終於願意求醫。結果顯示他患有前列腺癌，經醫生說明各種治療方案後，妻子認為「可以切除腫瘤的話，就切咗佢啦！」，即使有可能影響性功能？她也說﹕「幾十歲冇所謂啦，切咗先啦，醫生！」我看了一看當事人，他一言不發卻欲言又止。同為男人，當然明白性功能受影響可不是「冇所謂」，而且病人的意願才最重要。最後因應病人病情及跟他獨自溝通過後，決定採取較新的治療方案——用達芬奇機械臂微創手術切除前列腺，保留了供應勃起功能的血管神經束，令病人繼續維持正常性功能。<\/p>\n

荷爾蒙藥×化療藥 延長壽命<\/p>\n

近年，對於在晚期才確診前列腺癌的病人，醫學界開始提倡荷爾蒙藥物及化療並用的混合治療。過往，醫生會在荷爾蒙藥物失效時才採用化療，但有研究發現，若於荷爾蒙藥物治療期間，在適合的病人身上同時配合化療藥物，能延長14至22個月的壽命。對晚期病人而言，這無疑是個福音。<\/p>\n

■前列腺癌／增生 徵狀相似<\/p>\n

年長男性常有前列腺腫大的情况，通常是良性的前列腺增生，但徵狀與惡性腫瘤有很多相似之處﹕<\/p>\n

◆排尿困難<\/p>\n

◆排尿時刺痛<\/p>\n

◆排尿帶血<\/p>\n

◆排尿次數頻密（於晚間尤甚）<\/p>\n

◆排尿不順或微弱，並且時有阻滯<\/p>\n

註﹕前列腺癌通常第一個徵兆是背痛、臀部痛和骨盆痛，但此時癌細胞已經擴散到骨骼<\/p>\n

資料來源：香港癌症基金會網頁<\/p>\n

■知多啲<\/p>\n

前列腺癌誘因﹕年紀大 多肉少菜少運動<\/p>\n

香港是國際大都會，香港人亦愈來愈「西化」，快餐、多肉少菜的飲食文化已是生活的一部分；加上少做運動，間接造成不少健康問題。對於男士們而言，最擔心的莫過於患上前列腺癌。大家不要感到驚訝，因為近年本港前列腺癌的數字的確一直都在上升，所以男士們要更加關注前列腺健康。<\/p>\n

前列腺是男性生殖系統的腺體，位於膀胱頸與尿道之間，是負責分泌精液的主要器官，提供營養及輔助輸送精子。年紀大、男性荷爾蒙、遺傳因子、飲食習慣等，都是引致前列腺癌的誘因。<\/p>\n

男士們平日應減少進食紅肉及動物脂肪的食物，一旦出現下尿道病徵，如尿頻、小便困難、小便或精液帶血等，便應盡快求醫，不要諱疾忌醫；同時，伴侶亦應給予支持和鼓勵，好讓另一半有信心和動力抗病。<\/p>\n

文：姚銘廣（泌尿外科專科醫生） <\/p>\n

統籌：鄭寶華<\/p>\n

編輯：梁小玲<\/p>\n

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