大体积良性前列腺增生患者高值PSA临床分析

Clinical investigation on the source of elevated serum PSA in BPH patients with large-volume prostate

目的 探讨大体积良性前列腺增生 (BPH)患者高值血清前列腺特异抗原 (PSA)的来源。 方法 对 2 7例术前PSA值 8.1～ 75 .1ng/ml,直肠指诊前列腺≥Ⅲ° ,超声测量前列腺体积 >5 0ml,无前列腺癌 (PCa)迹象的排尿困难患者 ,采用耻骨上前列腺切除术及术后PSA追踪检测方法 ,分析术后PSA值变化的原因以及术前高值PSA的来源。 结果 2 7例切除腺体 4 0～ 1 85g ,平均 82 .7g。病理检查 2例发现PCa灶 ,2 5例未发现PCa灶。术后 1个月内 1例有PCa灶者PSA上升 ,2 6例迅速下降至正常范围。 2 4例获随访 1 7～ 5 7个月 ,PSA 0 .0 8～ 2 .39ng/ml,平均 1 .1 6ng/ml。 结论 大体积BPH患者的高值PSA多源于前列腺移行区增生腺体 。

Objective To investigate the source of the elevated serum prostatic specific antigen(PAS) in prostate hyperplasia patients with large volume prostate. Methods Open surgery (ie,suprapubic prostatectomy) was performed in 27 patients who had a preoperative PSA between 8.1 and 75.1 ng/ml and the volume measured by ultrasonography over 50 ml,DER≥Ⅲ° size,but without symptoms and signs of prostate cancer (PCa).The 27 patients were post operatively followed up to measure the serum PSA,to analyze the change in PSA and the source of pre operative elevated PSA. Results The post operative gross examination showed that the average weight of the prostate enucleated was 82.7 g (40 to 185 g).Pathological evaluation of the surgical specimen revealed that no prostate cancer lesion was found in 25 patients;however,PCa lesions were found in 2.Within 1 month the PSA rapidly dropped down to normal in 26 patients;however,in the remaining one with pathologically proven PCa,PSA increased.24 patients were followed up between 17 and 57 months after surgery.The average PSA level was 1.16 ng/ml(0.08 to 2.39 ng/ml). Conclusions In BPH patients with large volume prostate the increased PSA originates from hyperplastic gland (transition zone),not from the peripheral zone.