Prostate cancer in Western countries are leading the incidence of the first. Taiwan's informal survey urologist number of patients diagnosed with prostate cancer, the incidence per million population of about 16 people, average age of initial diagnosis of 67.8 years old. Per 100,000 population 40 to 45-year-old incidence of 0.23% over the age to 80 per 100,000 population to 32 percent higher, at 50 years of age the incidence rate of three times the mortality rate, age, the greater the mortality rate more high. Taiwan's Chinese and whites, the age of 50 men over the age of one third to one quarter have already latent prostate cancer. According to the Department of Health statistics, the number of deaths, the number of people die each year from prostate cancer has been increasing trend in the past nineteen years has increased fourfold. According to this increase in the ratio of view, the projection after a few decades Taiwan has at least a thousand people a year die of prostate cancer.
The treatment of advanced prostate cancer there is no magic formula, relying on orchiectomy and hormone replacement therapy can improve most of the patient's symptoms, but will eventually be transferred step by step toward the deterioration of one death. The early diagnosis of prostate cancer is therefore essential.
Traditional endocrine therapy by surgery or drug therapy alone can reach a few of the effects of castration of male hormones, including: (1) orchiectomy, (2) oral female hormone preparations, and (3) LHRH Analogues three subcutaneous treatment law, its clinical efficacy homogeneous approximation. Orchiectomy under local anesthesia in the implementation of 3-8 hours in the postoperative period can be Su-male serum concentration fell to castration, is the most traditional, fast and effective treatment method. However, patients have been psychologically castrated feelings, thereby affecting the degree of acceptance of this treatment. Although orchiectomy Another advantage of the merger in patients with severe pain of bone metastasis when orchiectomy can achieve rapid pain relief effect.
To sum up, in Taiwan, approximately every three to a quarter of the elderly contain latent prostate cancer, perhaps because of the past decade changes in environmental factors and life expectancy results of clinical prostate cancer incidence and in mortality has increased the trend of speed has become the most common male urinary system cancer. For the terminally ill can no cure, only by early diagnosis and early imposed prostate surgery or partial eradication of radiation, isotope control treatment in order to have radical treatment opportunities.
[Cancer metastatic bone pain]
The domestic top ten causes of death, cancer is still the number one adversary. Cancer of the high incidence of bone metastases, while the male rate of bone metastasis of prostate cancer up to 80%. Metastatic bone cancer patients, about 50-80% have bone pain symptoms, and many are drug treatment of pain difficult. Generally speaking, the more the spread of cancer, the patients on the higher probability of pain. Explore the cancer can be transferred to the bone by two ways. One for the infringement of sponge bone marrow cavity, one for the Hastelloy tube by periosteal bone dense part of violations. However, some 15% of patients did not see the transfer of pain would happen. Bone pain showed only in the non-terminal cancer and may occur at any given time. The reasons for the complexity of cancer pain, treatment methods of diversification, including the use of a variety of analgesic drugs, narcotic analgesics, systemic radiation therapy, and even surgical treatment and behavior therapy have. Its purpose is to make the patients were free of pain of suffering, improve quality of life, to live with dignity; to allow patients in a warm, non-painful circumstances, survive the rest of his life.
[How to help cancer metastatic bone pain?]
Ways analgesics, including traditional non-steroidal analgesics, narcotic analgesics, in vitro irradiation and radiation isotope control analgesic treatment of pain. The first two have to worry about the toxicity of drugs and addiction. To in vitro irradiation of extreme pain may cause bone marrow suppression, gastrointestinal discomfort, side effects such as hair loss. Radioisotope therapy until the last ten years has it begun to expand the use of. Easy to say that the advantages of isotope therapy generally have: 1. Comparison would not hurt the surrounding normal tissue; 2. Targeting specificity, and low toxicity characteristics. In fact the real mechanism of clinical pain is still studying in the medical community. As the radioisotope treatment, want to kill tumor cells is much higher than the required dose of analgesics doses, so the pain of cancer pain are palliative in nature and did not take too high doses. Pharmacy use this pre-treatment, need to be excluded such as nerve root compression, osteoarthritis, musculoskeletal lesions and tumor invasion of the possibility of soft tissue pain. Europe, the United States has opened many insurance are paid Strontium -89 therapy, and for a variety of cancer patients with metastatic bone pain giving the drug, hoping to alleviate or eliminate the disease of bone pain.
[Radioisotope strontium -89 brief introduction]
Strontium -89 therapy are the main indications for bone metastases of the cancer and bone pain, especially by the hormonal treatment of prostate cancer patients were invalid. The drug in patients with contraindications are the use of this drug before, and if serious bone marrow suppression, or event such as the number of neutrophil and platelet severely reduced, are not recommended to receive this treatment. This agent in the organization penetration distance of about 8-10mm, and the biological half-life of more than 50 days. Analgesic effect is often sustained 3-14 months.
Patients before treatment could be given a nuclear medicine bone scan to determine the location and number of bone metastases, patients of conventional blood test should also be noted that white cell count, platelet count or serum PSA concentration after treatment is also in need of regular blood tests every 4-8 weeks once only . -89 Strontium metabolism mainly through the kidney drained by a small number of bile discharged, the drug metabolites will be placed in a stool or urine, so patients after the toilet flush twice as long as many, or the event of any splash urine immediately wipe, you can prevent pollution. Staff must wash their hands after work, contamination of clothing is also required to clean and separate from other clothing. Furthermore Strontium -89 therapy spacing shall be separated for more than 3 months. This drug is a radioactive drug, can only be in hospitals by the nuclear medicine professionals use to give. Drugs in vivo injection first inside, and some patients will complain about aching bones, this is a temporary phenomenon, on behalf of the drug appears to enter the local site of bone metastasis, the role of happened.
Taking strontium -89, hematopoietic system will produce a small amount of inhibition, a slight reduction in white blood cells and platelets are predictable. Than the number of platelets before taking this medicine 10 to 40 percent slightly lower, but after a period of time be able to resume. By Strontium -89 discharged by the kidneys, if the seriousness of patients have renal dysfunction, use of this drug should be considered dangerous.
Strontium -89 release only pure beta particles, is a rather long half-life of 50.52 days for. Radiation and its only plastic or glass syringes barrier to achieve the effect of health care workers in contact with the patient need not worry about the radiation exposure injury, safety, fewer side effects.
[Medical expenses instead of savings]
Sr-98 in metastatic bone cancer pain has not yet included in the current domestic health insurance pay for items. However, according to the report of Canada, the use of Sr-89 to treat cancer patients with metastatic bone pain of their total medical costs an average of 16,570 yuan Canadian dollars. Without the use of Sr-89 therapy in patients with total medical costs an average of 23,688 yuan Canadian dollars. An average reduction in total medical costs 7118 yuan Canadian dollars (equivalent to approximately NT 14-160000 yuan on the spectrum), is indeed a big savings in costs. If we try to identify the original, because the use of Sr-98 after treatment relative to substantial reduction of the use of traditional non-steroidal analgesics, narcotic analgesics analgesic agents and in vitro irradiation of the cost. Therefore, the proposed National Health Insurance Bureau Sr-98 as soon as possible the transfer of bone cancer pain included in pay items. Nevertheless, substantial benefit not only required the transfer of bone cancer pain in patients suffering from pain, improve quality of life, and live in dignity. On the other hand can save a lot of medical expenses, control of the National Health Insurance Bureau is currently possible substantial losses.
[Looking]
Taipei Veterans General Hospital has completed nearly 110 cases of prostate cancer bone pain Strontium -89 therapy in clinical experience. Statistics show that strontium -89 treatment of metastatic bone pain remission rate of 65-70%, foreign experience around nearly 80%. Patients can reduce the pain and greatly enhance their quality of life. Observation shows that a small number of patients only minor rough white blood cell and platelet count decreased, there is no discomfort or other serious complications, one can be said to be very safe and effective treatment of metastatic bone pain. If necessary, patients can be re-treatment once every three months. Is a promotion of nuclear medicine isotope treatment.
[Conclusion]
Radioisotope Strontium -89 therapy prostate cancer metastasis bone pain, safety, fewer side effects. At present, the Court will continue to actively seek into the National Health Insurance project.
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