分析前列腺增生术后发现的前列腺癌的临床特征与预后(附13例临床资料)  

Clinical characteristics and prognosis of prostate cancer after prostatectomy for benign prostatic hyperplasia in 13 cases

作　　者：陆超[1] 花豹 茅原申[1] 顾欣[1] 李文峰[1] 顾豫飞[1] 潘惟昕[1] 童福坤[1] 张士青[1] 蔡志康[1] 王忠[1] Lu Chao Hua Bao Mao Yuanshen Gu Xin Li Wenfeng Gu Yufei Pan Weixin Tong Fukun Zhang Shiqing Cai Zhikang Wang Zhong(Deparanent of Urology, No.g People＇s Hospital, Medical College, Shanghai Jiaotong University,Shanghai 201900, China)

机构地区：[1]上海交通大学医学院附属第九人民医院(北部)泌尿外科,上海201900

出　　处：《中国男科学杂志》2017年第2期29-32,共4页Chinese Journal of Andrology

摘　　要：目的分析前列腺增生术(BPH)后发生前列腺癌(Pca)的临床特征及预后,提高对BPH切除术后发现的Pca的认识。方法回顾性分析我院2006年3月至2016年9月共收治的13例因BPH行前列腺切除术后发生Pca病人资料。Pca患者年龄74~85岁,平均81.3岁,诊断Pca距BPH手术时间4个月至21年,平均4.6年。BPH手术前资料:3例未行前列腺特异性抗原(PSA)检查,10例行PSA检查,其中2例正常,7例在灰区(4~10ng/m L),1例异常升高;5例为耻骨上经膀胱前列腺摘除术,8例行经尿道前列腺切除术(TURP)。术后再次就诊时的主要症状:8例为排尿困难,2例肉眼血尿,2例为排尿困难伴有肉眼血尿,1例无症状,在随访时发现PSA异常。肛指检查2例为BPH,11例扪及硬结疑Pca。B超检查6例诊断BPH,7例疑Pca。PSA均异常升高。病理诊断均为前列腺腺癌,其中1例行TURP获得病理确诊,12例行经直肠前列腺穿刺获得病理确诊。所有患者均接受内分泌治疗,其中8例行手术去势+抗雄药物治疗,3例行药物去势+抗雄药物治疗,1例仅手术去势,未服抗雄药物,1例仅抗雄药物治疗,未去势治疗。3例行内分泌治疗(手术去势)外,再行TURP术。结果 1例3年后失访,12例得到随访。1年、3年、5年生存率分别为100%(13/13)、76%(10/13)和50%(6/12)。死亡6例中3例为Pca相关死亡,3例为非Pca死亡。结论 BPH与Pca的起病部位不同,BPH切除术后仍可能发生Pca,术后应定期随诊,及早发现并治疗BPH术后的Pca;高龄患者Pca发病缓慢。Objective To analyze the clinical features and prognosis of prostate cancer （PCa） after prostatectomy for benign prostatic hyperplasia （BPH）, and improve the understanding of this disease. Methods Clinical data of 13 patients with Pca, who confirmed by pathological examination from March 2006 to September 2016, after prostatectomy for BPH were analyzed retrospectively. The mean age was 81.3 years old（range from 74 to 85 years old）. The mean intervals between prostatectomy for BPH and the diagnosis of prostate cancer was 4.6 years （range from 4 months to 21 years）. Clinical data of 13 cases underwent operation for BPH： The serum prostate specific antigen（PSA） was determined in 10 patients with BPH, the values of PSA were normal in 2 cases, were in gray area （4-10ng/mL） in 7 cases and elevated in one case. The surgical methods of BPH were suprapubic prostatectomy in 5 cases and transurethral resection of the prostate （TURP） in 8 cases. The main symptoms of those who needed retreatment were dysuria in 8 cases, hematuria in 2 cases, dysuria with hematuria in 2 cases, no symptom with abnormal PSA in one case. Digital rectal examinations（DRE） were abnormal in 11 cases. B ultrasound examinations were abnormal in 7 cases. PSA was elevated in all cases. Histopathology diagnosis were adenocarcinoma of prostate and established by TURP in one case and ultrasound guided transrectal core biopsies of the prostate in 12 cases. All cases received hormonal therapy, among them 8 cases were bilateral orchiectomy combined with antiandrogen drugflutamide, 3 cases were drug castration combined with antiandrogen drugflutamide, one case was bilateral orchiectomyand, one case was antiandrogen drugflutamide only, 3 cases who were bilateral combined with antiandrogen received additional treatment of TURP. Results During the 4 months to 10 years follow-up, 12 cases completed following- up, one case was lost after 3 years follow- up. One-year, three-year and five-year survival rate were 100%（13/13）, 76%�

关 键 词：前列腺增生 前列腺切除术 前列腺肿瘤 预后 

分 类 号：R697.32[医药卫生—泌尿科学] R737.25[医药卫生—外科学]