7例膀胱移行细胞癌伴前列腺癌的诊断与治疗

Diagnosis and Treatment Strategies in Seven Cases of Transitional Cell Carcinoma of Bladder Combined with Prostatic Carcinoma

目的讨论膀胱移行细胞癌伴前列腺癌的诊断和治疗。方法对389例膀胱移行细胞癌患者中伴有前列腺癌的7例患者资料进行分析。结果 7例患者均经活组织检查和膀胱镜检查诊断为膀胱移行细胞癌,经前列腺穿刺活检,被诊断为前列腺腺癌。3例患者经尿道采用电切术将膀胱肿瘤及双侧睾丸切除,术后用丝裂霉素或者BCG对患者膀胱实施药物灌注,同时口服氟他胺治疗前列腺癌。1例患者的部分膀胱及双侧膀胱被实施切除,并在术后对患者的前列腺癌实施体外辅助放射治疗。3例实施膀胱前列腺全切术加回肠膀胱术。7例患者中,失访2例,随访5例,其中2例发生多发转移导致术后生存时间不到1年,另外3例在术后随访1.5～4.0年,恢复良好,未发现肿瘤复发或者转移。结论前列腺穿刺活检、TRUS、DRE、血清PSA测定、活组织检查和膀胱镜检综合检查是目前诊断前列腺癌伴膀胱移行细胞癌的主要方法。膀胱前列腺根治性切除是取得较好治疗效果的重要因素。

Objective To investigate the diagnosis and treatment of coincident vesical transitional cell carcinoma and prostatic carcinoma.Methods In 389 patients with vesical transitional cell carcinoma,7 cases also suffer from prostatic cancer were selected and their clinical data were analyzed.Results These 7 patients were diagnosed as coincident vesical transitional cell carcinoma and prostatic carcinoma by biopsy,cystoscopy and needle biopsy of the prostate.3 patients received the transurethral resection of bladder cancer and bilateral orchiectomy,and with bladder instillation of BCG or mitomycin and oral flutamide for prostatic cancer after operation.1 patient received partial cystectomy and removal of both testicles and external radiotherapy for prostatic cancer after operation.3 patient received ileal conduit Bricker operation together with resection of bladder.2 of 7 cases were failed to follow up.In other 5 cases,2 of them died of wide metastasis in 1 year.The other 3 remained well without recurrence or metastasis by the follow-up of 1.5 to 4.0 years.Conclusion The prostate needle biopsy,DRE,TRUS and PSA detection and cystoscopy are the main diagnostic options for coincident vesical transitional cell carcinoma and prostatic carcinoma.Radical resections of bladder and prostate should achieve a better outcome.