单纯PSA增高大前列腺体积良性前列腺增生患者的诊治（附71例报告）

Diagnosis and treatment of large - volume prostate with simply elevated serum prostate - specific antigen benign prostatic hyperplasia patients （ report of 71 cases）

目的探讨单纯前列腺特异性抗原（PSA）增高大前列腺体积良性前列腺增生（BPH）患者的诊治。方法选取大前列腺体积（〉75ml）伴单纯PSA增高（〉4．00ng／ml，无其他前列腺癌迹象）的BPH患者共71例，采取B超引导下经直肠前列腺穿刺活检，分别在术后1周、1个月、3个月复查血清PSA。结果穿刺活检发现前列腺癌8例（11．27％），BPH63例（88．73％）。所有BPH患者均行耻骨上前列腺摘除术，术后病理检查均为BPH，术后1周有31例（49．21％）PSA降至正常[平均PSA（2．89±0．71）ng／ml，P〈0．01]；1个月有46例（73．02％）PSA降至正常[平均PSA（2．36±0．65）ng／ml，P〈0．01]，3个月有61例（96．83％）PSA降至正常[平均PSA（2．12±0．36）ng／ml，P〈0．01]，1例PSA6．77ng／ml，1例PSA18．34ng／ml。2例PSA仍高患者予重复穿刺，1例为BPH，予继续观察，1例为前列腺癌。结论单纯PSA增高大前列腺体积BPH患者穿刺活检阳性率低，可不予行前列腺穿刺活检而直接行耻骨上前列腺摘除术，术后定期复查血清PSA可预防前列腺癌的漏诊。

Objective To explore the diagnosis and treatment of large -volume prostate with simply elevated serum prostate -specific antigen（PSA） benign prostatic hyperplasia （BPH） patients. Methods Large -volume （ 〉 75 ml）prostate BPH patients underwent transreetal -ultrasound guided needle prostate biopsies only because of elevated PSA （ 〉 4.00 ng/ml, without clinically detectable prostatic carcinoma）. Suprapubic prostatectomy was performed in 71 BPH patients. The post - operative BPH patients were followed up to monitor the serum PSA within 1 week, 1 month and 3 months. Results Revealed prostatic carcinoma in 8 eases（11.27% ） and BPH in 63 eases （88.73%）.All BPH patients were received suprapubie prostateetomy and confirmed by the following pathology. Within 1 week, the PSA dropped down to normal [ （2.89 ± 0. 71 ） ng/ml, P 〈 0.01 ] in 31 patients （49.21%）. Within 1 month, the PSA dropped down to normal [ （2. 36 ± 0. 65 ） ng/ml, P 〈 0.01 ] in 46 patients （73.02%）. Within 3 months, the PSA dropped down to normal [ （2. 12 ±0.36） ng/ml, P 〈0.01 ] in 61 patients （96.83%）. The PSA still high （above 4.00 ng/ml） in 2 patients （6.77 and 18.34 ng/ml separately）, who received rebiopsies. The result showed BPH in 1 patient who was followed up continuosly, 1 patient was prostatic carcinoma. Conclusions Biopsies showed low ratio prostatic carcinoma in large - volume prostate with simply elevated serum PSA BPH patients. Suprapubic prostatectomy can be performed without biopsies in these patients. But it is important to follow up to monitor the serum PSA in case missing diagnosis of prostatic carcinoma.