攝護腺癌手術治療選擇：達文西手術與積極觀察哪種較佳？-泌尿科

攝護腺癌？

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杜醫師你好：我4/5體檢驗psa14.3！至醫院掛號檢查pas17于是做第一次切片是良性！但再驗psa18還是高！然後做MRI發現右側腫瘤再第二次切片發現3芯癌細胞 格里森4+5=9 指診T2 再做斷層掃描及骨骼掃描顯示未外移！我平常就覺得貪尿感覺儲尿量沒年經時多而已，醫生要我達文西手術切除！！請問醫生我真的要做到切除手術嗎？
海福刀或積極觀查不行嗎？
以下我病歷資料煩請杜醫生幫我。
感恩(檢查、驗項目)25004 Surgical pathology Level IV *4件25012 Immunohistochemieal stains , eac *2件(報告內容)1 . Prostate , right lateral , TRUS biopsy , adenocarcinoma , Gleason score 9 ( 4 + 5 ) . GradeGroup 5 , involving 3 / 10 cores and 15% .2 . Prostate , right medial , TRUS biopsy , benign prostate tissue3. Prostate , left medial , TRUS biopsy , benign prostate tissue4 . Prostate , left lateral , TRUS biopsy , benign prostate tissue[ 描述 )The specimen is submitted in four separated bottles labeled as A : right lateral , B : right medial , C : left medial , and D : left lateral , respectively fixed in formalin.The specimen labeled as A consists of ten tissue fragmentsmeasuring up to1 . 5x0 . 1x0 . 1 cm . in size . Grossly , they are tan and elasticThe specimen labeled as B consists of eight tissue fragments measuring up to 1 . 8 x0.1x0 . 1 cm . in size . Grossly , they are tan and elasticThe specimen labeled as C consists of three tissue fragments measuring up to 1. 7x0.1x0 . 1 cm . in size . Grossly , they are tan and elastic.The specimen labeled as D consists of three tissue fragmentsmeasuring up to 1 . 5x0.1x0 . I cm . in size . Grossly , they are tan and elasticAll for section and labeled as: Jar 0A : Right lateral B: Right medialC: Left medial D: Left lateralMicroscopic Examination:I . Histologic Type : Adenocarcinoma , acinar type.2 . Histologic Grade:( A ) Right lateral region : Gleason score 4+5 = 9(B ) Right medial region : benign prostate tissue.(C ) Left medial region : benign prostate tissue.( D ) Left lateral region : benign prostate tissue.3 . Highest Grade Group : 54 . Percentage of Gleason Pattern 4 : 90%5 . Percentage of Gleason Pattern 5 : I0 %6 . Intraductal Carcinoma ( IDC ) : Not identified.7 . Tumor Quantitation:( A ) Right lateral region : 3 of 10 cores , involving 15 % of needle core tissues.( B ) Right medial region : None.( C ) Left medial region : None.( D ) Left lateral region : None.8 . Periprostatic Fat Invasion : Not identified9 . Seminal Vesicle / Ejaculatory Duct Invasion : Not identified.10. Lymphovascular Invasion : Not identified.11 . Perineural Invasion : Not identified.12 . Additional Pathologic Findings : None identified.13. Tumor Immunoprofile ( section A ) : AMACR ( + , diffusely ) ,CK5 /14 (loss of peripheral expression at tumor glands).

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滄舟，50~59歲男性，詢問日期：2021/08/13