PSA筛查在会阴Paget病中的价值

Value of PSA screening in extramammary Paget disease

目的:探讨前列腺特异性抗原(PSA)筛查在会阴Paget病中的价值。方法:回顾性分析2003年1月~2012年12月在我院治疗的63例会阴Paget病患者临床资料。本组患者术前均行PSA检测,对于血清PSA>4μg/L者行经直肠超声引导下前列腺穿刺活检术以明确病理诊断。将本组患者中PSA>4μg/L者所占比例和前列腺癌(PCa)的发生率分别与文献报道的一般人群中相应比例进行比较。结果:本组63例患者均经病理证实为Paget病。19例(30.2%)患者肿瘤浸润至真皮层,2例(3.2%)累及提睾肌,4例切缘阳性。术前血清PSA>4μg/L者14例,在全组患者中所占比例(22.2%),明显高于一般人群中PSA筛查时血清PSA>4μg/L的比例(6.7%)。14例血清PSA>4μg/L的Paget病患者中6例(42.9%)经前列腺穿刺活检证实合并有PCa,其发生率远高于PSA>4μg/L的一般人群中PCa的发生率(25%~30%)。结论:与一般人群相比,会阴Paget患者更容易发生PCa,其具体机制有待进一步研究。

Objective： To investigate the v：alue of prostate-specific antigen （PSA） screening in extramammary Paget disease. Method： We retrospectively collected the data o{ 63 patients with extramammary Paget disease from Jan. 2003 to Dec. 2012. Serum total PSA was measured for each patient before surgery and transrectal ultrasound guided prostate biopsy was performed in patients with PSA^4 ~tg/L. The percentage of cases w^th PSAlm〉4/tg/L and the incidence of prostate cancer （PCa） were compared with the corresponding incidence in general population. Result： Paget disease was confirmed in all 63 cases. Nineteen cases （30.20//00） were found tumors infiltrated into dermis. Two cases （3. 2~） were noticed tumors infiltrated into cremaster and four cases were shown surgical margins were positive. The percentage of cases with PSA〉4 ltg/L was 22.2~ （14/63）, which was higher than general population （6.7~）. The incidence of PCa in extramammary Paget disease with PSA〉4 ~tg/L was 42.9 （6/14）, which is much higher than the incidence in general population （25--30~）. Conclusion： It is demonstrated that patients with extramammary Paget disease have an increased risk of developing PCa. However, further inves- tigations are required