Re: [問題] 攝護腺切片報告

[nolyab (nolyab)]

今天回診醫師說正子攝影看起來已經骨轉移了(但淋巴沒有看到），建議口服及注射健保
給付的荷爾蒙。

MRI報告:左側腫瘤4*4*5cm,T3aN0MX

1. 請問骨轉移是不是真的就不建議開刀了？後續需要轉看腫瘤科嗎？

2. 詢問醫師可以控制多久，醫師沒有給明確的答覆，希望有病友可以分享一下後續的治
療及存活時間，感激不盡


6/16今天去申請PSMA病歷報告，心理有一點底…似乎只能荷爾蒙治療了？

但還是很不能接受PSA才29，竟然已經轉移5個地方了…

Impression:
묠PROMISE miTM classification: miT3aNOM1b(diss), BCR restaging
묠Compatible with prostate cancer with bone metastasis at the following PSMA-a
vid areas (PSMA-RADS
5). Clinical correlation is recommended:
margin, rostate bed (PRIMARY 3): LB, LM (with possible extracapsular extension
 at left anterior
-- the skeleton: the skull, the left scapula, the L5 vertebra, the bil. ilia.
묠Increased PSMA uptake a t:
- the left 8th rib may be due to bone metastasis, though trauma, unspecific bo
ne uptake or inflammation can be this picture. (PSMA-RADS 3B)
-- the LUL and RUL (3 foci) of lung maybe due to inflammation/infection, thoug
h lung metastasis cannot be ruled out (PSMA-RADS 3C). Suggest further evaluati
on or close follow-up.
RADS 2 right bucco-facial area may be due to infection/inflammation. Tumor is
less likely (PSMA-
-- the other parts of the bilateral ribs may be due to unspecific bone uptake
or less likely bone metastasis (PSMA-RADS 2).
> Other image findings as above descriptions.
묠No definite evidence of PSMA-avid tumor is demonstrated elsewhere. Tumor wit
h tiny size, poor PSMA-avidity or obscured by physiological activity can't be
ruled out. Clinical correlation is recommended.


※ 引述《nolyab (nolyab)》之銘言：
: 家父70歲，PSA:29.29，
: 切片報告顯示格里森4+4，
: 1.切片報告看不太了解，想請問這能夠推估大概第幾期嗎？好讓自己心裡有個底
: PATH. DX.: 1. Prostate, left, punch biopsy --- Adenocarcinoma,
: Gleason's score: 4+4=8, Grade group 4 （3/6. 5%）. 2. Prostate, right，
: punch biopsy -- No malignancy. Ancillary study for diagnosis: 1:
: Immunohistochemistry stains for HMWCK (loss of basal cells) and alpha-methyl
ac
: yl-CoA racemase (+) done in section A. 2.
: Immunohistochemistry stains for HMWCK (highlight preserved basal cells) and
al
: pha-methylacyl-CoA racemase (-) done in section B.
: Gross description: The specimen consists of 1) 6 strips of gray white soft t
is
: sue, up to 1.7x0.1x0.1 cm, labeled as "left". All for section: B. 2) 6 strip
s
: of gray white soft tissue, up to 1.9x0.1x0.1 cm, labeled as "right".
: All for section: A. Microscopic description: 1. Section shows focal prostate
 t
: umor with ill-defined glands exhibiting poorly-formed glandular lumina, and
ci
: rcumscribed cribriform glands. 2. Section shows prostate tissue with variabl
y
: glandular hyperplasia. No evidence of malignancy is seen: Note: This case ha
s
: been peer reviewed by two doctors.
: 2.醫師說切片完要再等一個月才能做MRI，想請問這一個月我們能做什麼？
: 3.看切片報告時，有打一隻荷爾蒙針。想請問這是表示不太樂觀的意思嗎？（因為查網
路
: 都是說荷爾蒙療法屬於最後一線才使用）
: 4.彰基的陳俊吉醫師不知道有沒有人看過，因目前苦惱於不知道要找那個醫師
: 感謝各位癌友及家屬，第一次遇到親人罹癌真的不知道該怎麼辦

--
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推 mystery7631: 即便不手術，也可以用最新納入給付的SBRT高劑量五天
→ mystery7631: 照下原發部位（原發部位健保給付），然後自費SBRT照
→ mystery7631: 轉移部位，配合吃二代+ADT打針，這樣應該是最積極的
→ mystery7631: 療法了，如果醫生不願積極治療我覺得可以換醫生沒問
→ mystery7631: 題
→ mystery7631: PSA 29不一定有轉移 別放棄局部的積極治療
→ mystery7631: 如果是照F-18 PET/CT 偽影機率很高（高達2/3是偽影）
→ mystery7631: 我自己是會尋求積極治療（放射或手術皆可，若真的小
→ mystery7631: 轉移我比較推放療，比較不傷身）
推 kennyluck: 有樣本可以去做個基因檢測 ASCO剛有新結果
※ 編輯: nolyab (1.168.232.68 臺灣), 06/16/2026 14:33:22
→ mystery7631: 雖然不甘心，但這樣的報告應該是能健保申請二代荷爾
→ mystery7631: 蒙了（大於3處，一處非中軸骨）一個月可以省5-6萬三
→ mystery7631: 年月200萬藥費，能的話請醫生申請最新也最貴的daralu
→ mystery7631: tamide，副作用最小
推 mystery7631: darolutamide 藥不會進腦部，所以副作用最少，但也
→ mystery7631: 最貴自費一個月要近7萬，次之選Xtandi 再其他的就不
→ mystery7631: 要了