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Diagnosis & Tatalaksana Hipertrofi Prostat Dan Kanker PR
Diagnosis & Tatalaksana Hipertrofi Prostat Dan Kanker PR
Diagnosis & Tatalaksana Hipertrofi Prostat Dan Kanker PR
Hyperthropi Prostat
dan
Kanker Prostat Masa Kini
Dr. Rochani
Prostate anatomy – urethral division of gland
Reproduction
Antibacterial
T = testosterone
LH = luteinizing hormone
LH – RH = luteinizing
hormone – releasing
hormone
DHT = dihydrotestosterone
Smooth
Prostate Bladder
muscle
Symptomatic BPH
Edwin M. Meares Jr, MD, Differential Diagnosis of Prostate Disorders, 1993
Pathophysiology of the urinary bladder
in obstruction
Ureteral dilatation
Obstructive uropathy
Azotemia
Renal damage
Renal failure
Edwin M. Meares Jr, MD, Differential Diagnosis of Prostate Disorders, 1993
DIAGNOSIS
PEMBESARAN PROSTAT JINAK
ANAMNESIS
ANAMNESA
• PROSES & LAMANYA GGN BERKEMIH
• Menilai sendiri
• Ringan = 0–7
• Sedang = 8 – 19
• Berat = 20 - 35
BS (Bother Score)
• Lebih mudah, pilihan terapi & follow up
• 0 – 6
o COLOK DUBUR
TONUS SFINGTER ANI
PROSTAT
UKURAN ( obstruksi)
KONSISTENSI
NODUL
NYERI TEKAN
Masa di rectum
• PYURI,
• PROTEINURI (?),
• GLUKOSURIA.
(Cockett et all 1993, McConnell et all 1994)
UREUM / KREATININ
• 13,6% (0,3 – 30%) BPH + insufisiensi renal
(McConnell et all 1994)
LABORATORIUM
o PSA
• Dihasilkan oleh Jaringan Prostat Jinak
dan Ganas.
• Terdapat False (+) / (-).
• Nilai normal (< 4 ng/dl).
• Biopsi :
1. > 4ng/dl
2. 4 – 10 ng/dl bila PSAD (PSA/Vol prostat) > 0,15
UROFLOWMETRI
UROFLOWMETRI
Tidak infasif (nyaman)
Q MAX (MAX. FLOW RATE)
NORMAL ( 15 – 25 CC/DET)
Ringan (12 – 14 cc/det)
Sedang ( 8 – 12cc/det)
Buruk ( <8 cc/det)
Jumlah kencing
>150cc
UROFLOWMETRI
Studi Adam - Griffith dari 180 kasus
(100% < 12 cc)
Minimal (< 50cc) (Di Mare et all 1963)
Sedang (50 – 100cc)
Banyak (>100cc)
TRUS (Trans Rectal Ultrasound)
BENTUK & UKURAN PROSTAT
Rekomendasi Terapi :
Hipertermi
Stents
TUIP
AREA TERTENTU
TRUS (Trans Rectal Ultrasound)
TRUS
•USG TRANSREKTAL
•BIOPSI PROSTAT
URODINAMIK
b.Dustaterit (Avodat)
Indikasi operasi / Tur prostat
Indikasi
1. Prostat kurang dari 60 gram
ASKESKIN, JAMKESMAS)
TUR Prostat
Komplikasi TUR prostat
1. Perdarahan yang memerlukan
transfusi
2. Perforasi kandung kemih
3. TUR syndrome
4. Retrograde ejakulasi
7. Impotensia (?)
TUR Prostat
American Cancer Society 2010
Signs and Symptoms –
Advanced Disease
Signs and symptoms of advanced prostate cancer
include:
• Fatigue
• Loss of appetite
o A focused physical examination
to assess :
the suprapubic area for bladder
distention
motor and sensory function of the
perineum and lower limbs.
o A digital rectal exam (DRE)
evaluate anal sphincter tone and the
prostate gland :
approximate size,
consistency, shape and
abnormalities suggestive of
prostate cancer.
Prostate Imaging & Biopsy with Transrectal
Ultrasound
Biopsi prostat dengan cara mengambil jaring
Dengan jarum besar sebanyak 10‐12 core
Increased PSA levels equate to
increased prostate cancer risk
The chance of having prostate cancer increases with increasing
PSA:
• About 15% of men with PSA<4 will have prostate cancer on
biopsy
• Men with a PSA in the borderline range (4‐10 ng/ml) have a
25% chance of having prostate cancer
• PSA >10 ng/ml is associated with a 50% likelihood of
prostate cancer
Catalona W et al. JAMA 1998; 279(19):1542
Heidenreich A et al. EAU Guidelines 2009 available at: www.uroweb.org accessed Sept 2010
Schröder FH, ECCO‐ESMO 2009; Educational Book p402
American Urological Association 2009. Prostate Specific Antigen Best Practice Statement
American Cancer Society 2010
STAGING, GRADING
AND
MANAGEMENT
Gleason Score
o Most common grading
system for prostate cancer
• Two grades (1‐5) are added to
define the score
• Numbering each type from 1 for
the least affected up to 5 for the
most affected
o Histopathological grade
o Gives a measure of tumour
aggressiveness
o Based microscopic
Gleason score Aggressiveness of Prostate
examination Cancer
2‐4 Low
• pattern of infiltration
5‐6 Moderate
• degree of differentiation
7 Intermediate
• 5 cellular patterns recognised
8‐10 High
American Urological Association 2007
STAGE – How far the cancer has developed
Stage 1 - the cancer is small and
contained within the prostate.
Stage 2 - the cancer is larger and may be
organs, or to bone.
Staging
Staging
Staging
Disease Management: Prostate Cancer
Potential Treatable Population
60-70% 10-20%
20%
Watchful
waiting Surgery RXT Hormonal
Ablation
therapy
RXT 95%
Hormonal
Surgery therapy
60%
RXT
Chemotherapy
IUA Guidelines on Prostate Cancer
RISK Age