真性与假性前列腺偶发癌单中心病例特征分析

A single center retrospective analysis of absolute and pseudo-incidental prostate cancer

目的︰分析真性前列腺偶发癌(AIPCa)和假性前列腺偶发癌(PIPCa)的临床特点。方法︰回顾性分析2013年1月至2019年10月大连医科大学附属第二医院52例诊断为前列腺偶发癌(IPCa)患者的临床资料。中位年龄77.5(55~93)岁;国际前列腺症状评分(IPSS)中位值27.7(12~35)分;48例术前行前列腺超声检查,前列腺体积中位值38.6(2.3~130.2)ml。48例行PSA检查,其中47例tPSA中位值6.7(1~46)ng/ml;1例tPSA>100 ng/ml。52例中13例行经尿道前列腺切除术(TURP),24例行经尿道前列腺剜除术(TUERP),15例行根治性膀胱前列腺切除术(RCP)。依据术前检查是否完善,有无前列腺穿剌指征,前列腺穿刺流程是否规范,区分为AIPCa和PIPCa。比较3种术式检出的IPCa患者的资料,比较AIPCa和PIPCa患者一般资料、病理及预后差异。结果3种术式IPCa患者年龄、IPSS,PSA,T分期、Gleason评分差异均无统计学意义(P>0.05),而3种术式的前列腺体积[39.7(9.80~64.10)ml,65.93(22.20~130.20)ml,23.46(2.34~41.60)ml]和前列腺组织切除率[45.3%(26.2%~50.0%),47.5%(45.0%~75.5%),100.0%]的差异均有统计学意义(P<0.001)。52例中AIPCa 21例,PIPCa 31例。AIPCa与PIPCa患者年龄[75.5(55.0~93.0)岁与77.1(63.0~87.0)岁],IPSS[23.8(12.0~35.0)与26.1(16.0~35.0)],前列腺体积[40.11(6.00~126.02)ml与52.27(2.34~130.20)ml],前列腺组织切除率[63.0%(45.0%~100.0%)与66.5%(26.2%~100.0%)].T,期比例[61.3%(19/31)与33.3%(7/21)].手术方式,Gleason评分的差异均无统计学意义(P>0.05),但AIPCa患者tPSA水平明显低于PIPCa患者[3.14(0.87~7.38)ng/ml与14.68(5.36~50.00)ng/ml,P<0.001]。术后随访6~78个月,中位随访时间33个月。AIPCa与PIPCa患者中分别有23.8%(5/21)与45.2%(14/31)随访过程中PSA升高,行根治性前列腺切除术或雄激素剥夺治疗;AIPCa患者无转移或死亡,PIPCa患者中2例出现骨转移,1例死于前列腺癌全身转移。结论PIPCa较AIPCa患者预后相对不良,PIPCa存在漏诊及临床低估可能。临床应严谨定义IPCa,严格遵守穿刺活检指征,强调PSA在肿瘤筛查及穿刺活检中的参考价值,慎重对待PSA异常时的阴性穿刺活检结果,避免术前漏诊。

Objective To analyze the clinical features of absolute incidental prostate cancer(AIPCa)and pseudo-incidental prostate cancer(PIPCa).Methods Between January 2013 and October2019,52 male patients who were diagnosed as incidental prostate cancer(IPCa)with their postoperativepathological examination in our center were included.None of them had any evidence of prostate cancerbefore.Their median age was 77.5(ranging 55-93)years old.48 cases underwent PSA examination.Themedian tPSA was 6.7(ranging 1-46)ng/ml,except l case tPAS>100ng/ml.The median IPSS score was27.7(ranging 12-35).48 cases accepted prostatic ultrasound examination.The median prostate volumewas 38.6(ranging 2.3-130.2)ml.Among them,13 patients underwent transurethral resection of theprostate(TURP),24 patients underwent transurethral enucleation and resection of the prostate(TUERP),15 patients underwent radical cystoprostatectomy(RCP).According to the patients’preoperativeexamination,AIPCa and PIPCa were redefined.Clinical characteristics,postoperative pathology and follow-up of the two groups were compared and analyzed.ResultsThere was no significant difference in age,IPSSscore,tPSA,T stage and Gleason score between the operation methods groups except for prostate volume andresection ration of prostate(P>0.05).Among those group,the sequence of prostatic resection ration wasRCP>TUERP>TURP(P<0.001).There was no significant difference in age,IPSS score,prostatevolume,proportion of TT and Gleason score between AIPCa and PIPCa groups.However,the analysisshowed higher tPSA(14.68 ng/ml vs.3.14 ng/ml)in PIPCa(P<0.001).With a mean follow-up of 33months(ranging 6-78 months),23.8%(5/21)patients in AIPCa group and 45.2%(14/31)patients inPIPCa group were found to have increased PSA and underwent radical prostatectomy or androgen deprivationtherapy in the follow-up.There was no metastasis or death in AIPCa group,while 2 patients had bonemetastasis and 1 patient died of prostate cancer in PIPCa group.Conclusions According to the indicationof prostate biopsy,PIPCa and AIPCa were defined.PIPCa has a relatively poor prognosis,some of them maybe missed diagnosis and clinical underestimation.In order to avoid missed diagnosis before operation,weshould strictly definc IPCa and follow the indications of biopsy,emphasize the reference value of PSA intumor screening and biopsy,and careful handle the negative results of biopsy when PSA is abnormal.