血清前列腺特异抗原4～10μg/L的前列腺癌“灰区”的诊断和治疗

Diagnosis and treatment of prostate cancer with prostate specific antigen 4-10μg/L

目的探讨血清 PSA 4～10μg/L 前列腺癌“灰区”的诊断与治疗特点。方法回顾性分析本科1998年5月至2004年2月间血清 PSA 4～10μg/L 的前列腺穿刺活检资料,对确诊前列腺癌的患者进一步研究其治疗及预后情况。结果 141例患者血清 PSA4～10μg/L,经直肠超声引导下前列腺穿刺后诊断前列腺癌34例(24.1%)。临床分期 cT1期3例,cT2期21例,cT3期6例,cT4期4例,cT1、cT2肿瘤的平均 Gleason 评分明显低于 cT3、cT4肿瘤。24例 cT1、cT2期肿瘤行前列腺癌根治术,4例 cT3肿瘤在4个月新辅助内分泌治疗后行前列腺癌根治术,2例 cT3肿瘤和4例cT4肿瘤行睾丸切除术。28例根治术的病理结果21例肿瘤局限于前列腺内.7例已侵出前列腺外,二者 Gleason 评分差异有统计学意义。平均随访42个月(18～69个月)。21例局限性前列腺癌患者PSA 未见升高,4例 pT3肿瘤术后出现 PSA 升高,1例出现多发性骨转移,无癌特异死亡。4例 cT4肿瘤在睾丸切除术后13～23个月因为血 PSA 明显升高或出现骨转移而加抗雄激素受体治疗,2例病情稳定带瘤生存,2例因为广泛癌转移死亡。结论对于血清 PSA 4～10μg/L 前列腺癌“灰区”的患者应常规行前列腺穿刺活检。PSA4～10μg/L“灰区”的前列腺癌并非都是早期癌。Gleason 评分对于判断术后病理分期有重要意义。根治性前列腺切除是局限性前列腺癌的有效治疗方法。

Objective To investigate the diagnostic and therapeutic characteristics of prostate cancer with prostate specific antigen（ PSA） 4-10 μg/L. Methods The data of prostate biopsies for the patients with PSA 4-10μg/L from May 1998 to February 2004 and the treatment and prognosis of these patients were retrospectively analyzed. Results In the 141 cases, 34 were diagnosed as prostate cancer, including 3 cT1, 21 cT2, 6 cT3 and 4 cT4. Mean Gleason score was 5.8, and the mean Gleason scores of cT1 and cT2 were significantly lower than those of cT3 and cT4. Twenty-four cases of cT1 and cT2 underwent radical prostatectomy. Four cases of cT3 recieved radical prostatectomy after 4 months of neoadjuvant endocrine therapy. Two cases of cT3 and 4 cT4 received castration. Pathological section from radical surgeries showed that 21 cases were organ confined and 7 were locally invasive. The difference of mean Gleason score between these two groups was significant in statistics. After 18 to 69 months （mean 42 months）follow-up, 21 organ confined cases were free survived, 4 locally invasive cases had biochemical recurrence and 1 ease had multifocal bone metastasis. No cancer-specific death happened. Two of 4 cT4 cases were still alive and 2 died of the tumor. Conclusions Routine needle biopsy is necessary for the cases with＂grave area＂PSA of 4～10 μg/L. Prostate cancers with PSA 4～ 10μg/L are not always early diseases. Gleason score is a very important index for determine the stage of pathology after surgery. Radical prostatectomy is an effective treatment for organ confined disease.