前列腺电切术后前列腺偶发癌的病理特点及预后分析

Pathological characteristics and prognosis of incidental prostate cancer after transurethral resection of prostate

目的探讨经尿道前列腺电切术后的前列腺偶发癌(incidental prostate cancer,IPCa)(即T1a-T1b期前列腺癌)的临床病理及预后特点,提高对该病的诊疗认识。方法回顾性分析2009年1月至2016年12月在北京安贞医院因良性前列腺增生(benign prostatic hypertrophy,BPH)而行经尿道前列腺电切手术(transurethral resection of prostate,TURP)病理回报前列腺癌的患者临床病理资料,计算IPCa发生率;比较BPH与IPCa两组患者的年龄、术前前列腺特异性抗原(prostate specific antigen,PSA)水平、前列腺体积、切除前列腺重量差异;所有IPCa患者分为T1a期和T1b期,比较两期患者的术前PSA水平、前列腺体积、切除前列腺重量、Gleason评分以及预后等指标差异。结果共580例TURP患者,术后检出IPCa患者16例,检出率为2.8%(16/580);BPH与IPCa两组患者的术前PSA水平、前列腺体积以及切除前列腺重量差异无统计学意义;16例IPCa患者中,T1a期7例(1.2%),T1b期9例(1.6%);T1a期IPCa患者的Gleason评分显著低于T1b期患者;T1a期、T1b期患者的术前PSA水平、F-PSA/T-PSA、前列腺体积、切除前列腺重量差异无统计学意义;所有患者行最大雄激素阻断(maximal androgen deprivation,MAB)治疗,中位随访时间(50.3±25.9)个月。T1a期患者的术后3个月和6个月PSA分别下降85.1%和97.5%;T1b期患者的术后3个月和6个月PSA分别下降86.9%和96.3%;随访期间非前列腺癌特异性死亡者2例,未见前列腺癌特异性死亡病例。结论本研究IPCa检出率为2.8%,MAB治疗对于T1a-T1b期前列腺癌是一种相对安全有效的治疗策略。

Objective To explore the clinical pathological characteristics and prognostic features of incidental prostatic carcinoma after transurethral resection of prostate（ TURP） and to improve the recognition in the diagnosis and treatment of incidental prostate cancer. Methods Five hundred and eighty patients who underwent TURP from Jan. 2009 to Dec. 2016 in Beijing Anzhen hospital were analyzed retrospectively. The general and clinical pathological data of patients suffer with incidental prostate cancer were collected in hospital. The age,preoperative PSA level,prostate volume and the weight of the resected prostate in two groups were compared between benign prostatic hyperplasia and incidental prostatic carcinoma; All the patients with incidental prostate cancer were divided into stage T1 a and T1 b group. The preoperative PSA level,prostate volume,the weight of the resected prostate,Gleason score and prognosis were compared between the two groups. Results Sixteen cases of incidental prostate cancer were detected and the detection rate of incidental prostate cancer after the TURP was 2. 8%（ 16/580）. There was no significant difference in preoperative PSA level,prostate volume and the weight of the resected prostate between the two groups of prostate hyperplasia and incidental prostate cancer; 7 cases of incidental prostate cancer patients belonged to T1a（ 1. 2%） and 9 cases belonged to T1b（ 1. 6%）. The Gleason score in stage T1 a was significantly lower than stage T1 b in incidental prostate cancer patients. There was no significant difference in preoperative PSA level,F-PSA/T-PSA,prostate volume and the weight of the resected prostate between stage T1 a and T1 b groups. All the patients accepted maximal androgen deprivation therapy. The mean follow-up time was（ 50. 3 ± 25. 9） months. The PSA level was decreased by 85. 1% and 97. 5% in stage T1 a patients after there and six months after TURP,while 86. 9% and 96. 3% in stage T1 b patients. One patient died of acute myocardial infarction in T1 a incidental prostate cancer patients and one patient die of renal failure in I1 b during the follow-up period. There were no cases of prostate cancer specific death. Conclusions The detection rate of incidental prostate cancer after the TURP was 2. 8%,and maximal androgen deprivation therapy for incidental prostate cancer is effective and safety.