摘要
目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。
Objective：To investigate the clinical manifestation of the low serum PSA prostate cancer.Method：A retrospective analysis of ten cases with low serum PSA prostate cancer was done.Ten patients with lower urinary tract obstruction or bone pain or abnormal physical examination were hospitalized with the average serum PSA of 1.968ng/ml.Prostate biopsy from puncture and/or TURP was done after the abnormal results of rectal exam,transrectal ultrasound and MRI of prostate for diagnosis.Seven of them were diagnosed as prostatic adenocarcinoma,two cases were diagnosed as small cell carcinoma,and the rest one case was squamous carcinoma.For two cases of small cell carcinoma of prostate,one was treated with drug castration＋androgen deprivation therapy,the other was treated with TURP＋drug castration＋androgen deprivation therapy.For seven cases of prostatic adenocarcinoma,two were treated with drug castration＋androgen deprivation therapy,one underwent surgical castration＋androgen deprivation treatment,two underwent laparoscopic radical prostatectomy,and two underwent TURP＋drug castration＋androgen deprivation therapy.The rest one patient with squamous carcinoma was treated with TURP＋drug castration＋androgen deprivation therapy.Result：Among the seven cases of prostatic adenocarcinoma the Gleason scores of six cases were≥seven point,and one case was four point.Eight patients of ten cases were T_3 and above,including three cases with bone metastasis.A mean follow-up period of 18 months demonstrated four cases died,three cases were found disease progression,and three cases were free from disease progression.Conclusion：Low serum PSA prostate cancer is characterized by concealing and high malignancy.Its diagnosis and follow-up do not rely on serum PSA.Endocrine therapy is not ideal,and imaging examination is necessary for postoperative follow-up in order to make sure of disease progression.
出处
《临床泌尿外科杂志》
2016年第1期59-61,64,共4页
Journal of Clinical Urology
