老年人低血清前列腺特异抗原前列腺癌病例报道并文献复习

Clinical and pathological analysis of prostate cancer with low level of serum prostate specific antigen： a report of 4 elderly cases and literatures review

目的提高对老年人低血清前列腺特异抗原（PSA）型前列腺癌的临床病理特征的认识。方法回顾分析328例前列腺癌患者资料，对其中4例低PSA型老年前列腺癌患者的临床病理资料进行分析，结合文献资料讨论低血清PSA前列腺癌的可能原因和诊断方法。结果4例患者平均年龄71．3岁，入院平均PSA值为1．96μg／L；2例患者肛指检查异常；穿刺病理诊断腺癌2例（其中1例为导管腺癌），神经内分泌癌2例。对2例前列腺神经内分泌癌行内分泌治疗；对其余2例前列腺癌行前列腺癌根治术加内分泌辅助治疗。结论低PSA型前列腺癌起病隐匿，易于漏诊，诊断和监测不依赖于PSA。需结合清游离PSA、PSA密度等多项指标及直肠指诊等基础检查协助鉴别诊断。

Objective To investigate the clinical and pathological features of prostate cancer with low level of serum prostate-specific antigen （PSA） in elderly patients. Methods Data of 328 patients with prostate cancer were retrospectively analyzed. Clinical and pathological data of 4 prostate cancer patients with low serum PSA level were analyzed. Potential risk factors and diagnostic methods of prostate cancer with low serum PSA level were discussed based on the clinical data combined with literatures. Results Mean age of the 4 patients was 71.3 years. Mean PSA value on admission was 1.96μg/L. 2 patients had abnormal digital anal examination results. 2 patients were pathologically diagnosed as adenocarcinoma after puncture, among which 1 had duet adenocarcinoma, and the other 2 patients were pathologically diagnosed as neuroendocrine carcinoma after puncture. 2 patients with neuroendocrine carcinoma of prostate were treated with endocrine therapy, and the other 2 patients were treated with radical prostatectomy plus auxiliary endocrine therapy. Conclusions Prostate cancer with low serum PSA level has an insidious onset, which is prone to miss the diagnosis. It should be paid sufficient attention for the diagnosis, and monitoring of prostate cancer is independent on PSA. Prostate cancer with low serum PSA level should be diagnosed in combination with some basic examinations such as serum free prostate specific antigen, prostate specific antigen density and digital rectal examination, et al.