前列腺导管腺癌临床诊治分析(附21例报告)

Clinical diagnosis and treatment of ductal adenocarcinoma of the prostate (Report of 21 cases)

目的:探讨前列腺导管腺癌(ductal adenocarcinoma of the prostate,DAP)的临床病理特征和治疗方法,提高对DAP的诊疗水平。方法:回顾性分析21例DAP患者的临床资料。6例无症状,仅发现前列腺特异性抗原(PSA)升高。排尿不畅伴尿频15例,其中反复血尿5例。2例后尿道肿物行经尿道膀胱肿瘤电切术确诊,1例经尿道前列腺电切术确诊,18例行前列腺穿刺活检和手术后确诊。4例接受内分泌治疗,17例行腹腔镜前列腺癌根治术。结果:17例病理证实为腺泡腺癌合并DAP,4例证实为纯DAP。切缘阳性10例,阳性率58.82%(10/17),神经侵犯5例,盆腔淋巴结阴性。1例患者内分泌治疗失败后行减瘤性腹腔镜前列腺癌根治术,术后4个月出现肺骨转移,未能接受化疗去世。所有患者随访8-80个月,术后生化复发2例,内分泌治疗控制。结论:DAP早期不易诊断,与前列腺癌不良的生物学行为密切相关,早期诊断、根治手术辅以内分泌治疗可使患者生存获益。

Objective: To investigate the clinicopathological features of ductal adenocarcinoma of the prostate(DAP) and improve the diagnosis and treatment of the disease. Method: The clinical data of twenty-one patients with DAP were analyzed retrospectively. Six cases were found elevated PSA value without any symptoms. A total of fifteen cases presented with dysuria and urine frequency, of which five cases suffered from gross hematuria. Prostate biopsy was performed in eighteen cases, transurethral resection of prostate was performed in one case, transurethral resection of bladder tumor was performed in two cases. Endocrine therapy was given to four cases and laparoscopic radical prostatectomy was done in seventeen cases. Result: The pathological results were confirmed as acinar adenocarcinoma with DAP in seventeen cases, and pure DAP was confirmed in four cases. The positive surgical margin was demonstrated in ten cases and the positive rate was 58.82%(10/17). The nerve invasion was found in five cases and the dissected pelvic lymph nodes were negative. One patient failed in endocrine therapy and followed by cytoreductive LRP. Unfortunely, he was revealed lung and bone metastasis four months later, and died without chemotherapy. All patients were followed up from eight to eighty months, and two patients of them suffered from biochemical recurrence, which was controlled by endocrine therapy. Conclusion: DAP is difficult to be diagnosed in the early stage, which is closely related to the poor biological behavior. Early diagnosis, radical prostatectomy combined with endocrine therapy can benefit the overall survival of patients.