良性前列腺增生术后前列腺偶发癌10年回顾性分析

Retrospective analysis of incidental prostatic carcinoma after surgery of BPH:ten years’ results

目的 分析良性前列腺增生 (BPH)术后前列腺偶发癌的特点、治疗方法和随访结果。 方法 回顾性分析 1994 - 2 0 0 3年因BPH行TURP或前列腺摘除术 15 11例资料。发现前列腺偶发癌 35例 ,年龄 6 3～ 82岁。腺癌 34例 ,T1a17例 ,T1b17例 ;前列腺移行细胞癌 1例。行内分泌治疗11例 ,观察等待 2 4例。 结果 33例随访 8～ 10 7个月 (5 5 .2± 2 8.6 ) ,失访 2例。治疗组 8例存活 ,死亡 2例 (因心血管病死亡 1例 ) ,失访 1例 ;观察组 2 1例存活 ,死亡 2例 ,失访 1例。T1a或T1b期观察等待患者的肿瘤特异性生存率之间差异无统计学意义 (P =0 .4 80 ) ;T1b期患者 ,观察等待与内分泌治疗患者的肿瘤特异性生存率之间差异无统计学意义 (P =0 .5 2 7)。 结论 PSA应用于临床后 ,BPH术后偶发癌的比例为 2 .3% ;对于偶发前列腺腺癌 ,可以观察等待。

Objective To evaluate the clinical featur es , treatment regimens and prognosis of incidental prostatic carcinoma after surge ry for BPH in the PSA era. Methods From January 1994 to December 2003,a total of 1511 patients diagnosed with BPH in our institute under went TURP or prostatectomy;35 of them were found to have incidental prost atic ca rcinoma.Their age ranged from 63 to 82 years.Pathologically,34 cases had prostat ic adenocarcinoma (including 17 cases of T 1a and 17 of T 1b),and 1 ha d transitional cell carcinoma of the prostate.Eleven patients received androgen -deprivation therapy,while 24 had only watchful waiting. Results Of the 35 patients,33 were followed up for 8 to 107 months with a mea n of (55.2±28.6) months;2 were lost.Of those who were treated,8 cases survived; 1 died of prostate cancer and 1,of cardiovascular disease.Of those who had watch ful waiting,21 cases survived;2 died of the disease.The T 1a patients had a lower mean Gleason score (3.0±0.87) than T 1b patients (4.6±2.0) ( P <0.001).For those who underwent watchful waiting,no statistic significant differ ence of tumor-specific survival rate existed between T 1a and T 1b gr oups ( P =0.480).For T 1b patients,no statistic significant difference of tumor-specific survival rate existed between those having watchful waiting and those undergoing androgen-deprivation ( P =0.527). Conclusions In the PSA era,the rate of incidental carcinoma of prostate after BPH surgery was 2.3%.Watchful waiting may be a treatment choice for patients with i ncidental carcinoma.