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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 features of low-serum prostate-specific antigen (PSA) prostate cancer. Methods: A retrospective analysis of 10 cases of low serum PSA prostate cancer clinical data: 10 patients with lower urinary tract obstruction or bone pain or physical examination admitted to hospital, the average serum PSA was 1.968ng / ml. Rectal examination, transrectal ultrasound, MRI abnormalities, puncture and / or prostate resection, of which 2 cases of small cell carcinoma of the prostate, 1 case of drug castration + anti-androgen therapy, and the other 1 case of prostate Surgical resection + drug castration + anti-androgen therapy; 7 cases of prostate adenocarcinoma patients, 2 cases of drug castration and anti-androgen therapy, 1 case castration castration + anti-androgen therapy, 2 cases of laparoscopic prostate Radical surgery, 2 cases of prostate resection + drug castration + anti-androgen therapy; 1 case of squamous cell carcinoma patients underwent prostatectomy + drug castration + anti-androgen therapy. Results: Postoperative pathological examination confirmed. Seven cases of prostate adenocarcinoma Gleason score, 6 cases ≥ 7 points, 1 case = 4 points. Of the 10 patients, 8 had T3 or more, and 3 had bone metastases. Ten patients were followed up for an average of 18 months, 4 died, 3 patients progressed, and 3 patients had no progression. Conclusions: The low serum PSA type prostate cancer has more occult onset and higher malignant degree. The diagnosis and follow-up are not dependent on serum PSA. The endocrine therapy is not effective. The postoperative follow-up should be performed regularly to confirm the progress of the disease.