前列腺癌筛查患者的临床病理特点及其意义

Mass screening prostate cancer and clinical comparison

目的通过分析集团筛查和临床诊断发现的前列腺癌，探讨前列腺癌筛查的临床价值。方法2000年1月至2008年1月共收治441例前列腺癌患者，分为两组，临床组为门诊收治的前列腺癌患者122例；筛查组为同期23183名50岁以上男性人群筛查发现的前列腺癌患者319例（均住院治疗）；对两组患者年龄、直肠指检阳性率、血清前列腺特异性抗原（PSA）、病理Gleason评分、分型及临床分期和治疗方法等进行比较。结果筛查组直肠指检阳性率为42．0％，低于临床组的79．5％。筛查组中PSA〉20．0μg/L的比例低于临床组。筛查组的中度分化腺癌占61．8％，高于临床组的29．5％，而低分化腺癌则相反。筛查组低于他的患者比例为56．1％，T3以上患者比例为43．9％；临床组低于T2的患者比例为25．4％，T3队七患者比例为74．6％。发生局部及远处转移患者，筛查组26．0％，临床组46．0％。临床组根治性前列腺切除术占9．8％；筛查组根治手术占18．2％。结论人群中筛查前列腺癌可以发现早期局限无症状的前列腺癌。

Objective To investigate the clinical value of the mass screening by analyzing the features of prostate cancer between mass screening patients and clinical patients. Methods From January 2000 to January 2008, 441 cases of prostate cancer （ including 122 patients from clinical diagnosis and 319 patients from mass screening 23 183 men who were more than 50 years old） were analyzed from age, digital rectal examination （DRE）, serum prostate specific antigen （PSA） levels and range, the Gleason＇s score and grade, clinical staging and therapy. Results 42. 0% of mass screening patients were inspected by DRE, it was lower than that （79. 5% ） in the clinical patients. The percent of patients with serum PSA levels of less than 10. 0 μg/L in mass screening group was higher than in clinical group, while the percent of patients with serum PSA levels of more than 20. 0 μg/L in mass screening group was lower than in clinical group. The percent of moderately differentiated degree of prostate cancer in mass screening group was higher than in clinical group, but it was on the contrary for poorly differentiated degree of prostate cancer . The percent of T1-2 prostate cancers in mass screening group was 56.1%, which was higher than 25.4% in clinical group. While, the percent of 33-4 tumors in mass screening group was lower than in clinical group. The percent of men undergoing radical prostatectomy in mass screening group was 18.2% , which was higher than 9. 8% in clinical group. The percent of men of locally advanced and far metastasis in mass screening group was 26. 0% , while was lower than 46. 0% in clinical group. Conclusion General investigation for prostate cancer is benefit to find asymptomatic cancer of early stage.