前列腺尿路上皮癌的诊疗分析

Diagnosis and treatment of urothelial carcinoma of the prostate

目的总结前列腺尿路上皮癌的诊断与治疗方法。方法回顾性分析2011年1月至2019年11月郑州大学第一附属医院收治的25例前列腺尿路上皮癌患者的临床资料。平均年龄(63.4±11.2)(39~85)岁。就诊原因:肉眼血尿13例,排尿困难9例,膀胱刺激征3例。25例PSA均<4 ng/ml。17例MRI检查提示膀胱及前列腺区异常信号,膀胱与前列腺分界不清;其中3例提示为前列腺癌侵犯膀胱,前列腺区呈团块状异常信号;14例提示为膀胱区菜花状异常信号,考虑膀胱癌侵犯前列腺,此14例中6例既往有膀胱癌病史,考虑为膀胱癌复发并侵犯前列腺,复查胸+全腹CT(平扫加增强)发现2例全身多发转移。余8例MRI检查提示前列腺区团块状异常信号。11例术前行膀胱镜检,均发现滤泡样病变并取活检,其中10例病理诊断为膀胱尿路上皮癌,1例为前列腺尿路上皮癌。25例均行手术治疗,14例先行经尿道诊断性电切术,其中6例分别于术后10、17、31、45、60、65 d行根治性膀胱前列腺切除术;1例术后15 d行根治性膀胱前列腺切除术+盆腔淋巴结清扫术。9例直接行根治性膀胱前列腺切除术,2例因术前诊断全身多发转移行经尿道姑息性电切术。结果25例术后病理诊断均为前列腺尿路上皮癌,其中12例为原发性前列腺尿路上皮癌;13例伴膀胱尿路上皮癌,为继发性前列腺尿路上皮癌。术后13例进一步治疗。继发性前列腺尿路上皮癌患者中7例行膀胱灌注治疗,2例行吉西他滨+顺铂(GC)方案化疗,1例行盆腔局部放疗;原发性前列腺尿路上皮癌患者中3例行内分泌治疗。共17例发现淋巴结转移,其中术前发现7例,术后病理诊断1例,术后定期复查盆腔MRI发现9例;17例中10例为区域淋巴结多发转移,7例为腹股沟区及腹膜后多发转移。共16例发现远处转移,术前发现2例;术后随访发现14例,其中全身多发转移灶4例,肺转移6例,骨转移者4例。25例平均随访(21.5±10.1)(2~36)个月,1年生存率为88%(22/25),2年生存率为40%(10/25),3年生存率为28%(7/25);7例生存期满3年者未观察到生存终点。结论盆腔MRI、膀胱镜检并取活检及定期前列腺尿道部随机活检有助于前列腺尿路上皮癌的明确诊断,确诊依赖于病理组织学检查,早期诊断有助于改善预后,治疗首选以根治性手术为主的综合治疗。

Objective To discuss the diagnosis and treatment of urothelial carcinoma of the prostate.Methods The clinical data of 25 patients with prostate urothelial carcinoma from January 2011 to November 2019 were retrospectively analyzed.Among the 25 patients,the age of onset was 39 to 85 years old,with an average of(63.4±11.2)years old,13 patient presented with gross hematuria,9 patients presented with dysuria,and 3 presented with bladder irritation.The PSA of 25 patients was within the normal range(less than 4 ng/ml).17 cases of pelvic MRI showed abnormal signals in the bladder and prostate area,3 cases indicated that prostate cancer had invaded the bladder,and 14 cases considered bladder cancer Invasion of the prostate suggests a cauliflower-like abnormal signal in the bladder area.6 of this 14 patients have a history of bladder cancer.All 25 patients underwent surgical treatment,and 14 underwent transurethral diagnostic resection,of which 6 cases accepted radical cystectomy later.One patient underwent radical cystectomy combined with pelvic lymph node dissection 15 days after the first operation.9 cases received radical cystectomy.2 cases undergoing transurethral palliative resection due to multiple metastases before the operation.Results The postoperative pathological diagnosis of 25 cases were all prostate urothelial carcinoma,13 cases were accompanied by bladder urothelial carcinoma,secondary prostate urothelial carcinoma,and 12 cases were primary prostate urothelial carcinoma.After the operation,13 patients were further treated.Among the patients with secondary prostate urothelial carcinoma,7 patients received bladder perfusion,2 patients received GC chemotherapy,1 patient received local pelvic radiotherapy.25 patients were followed up for 2 to 36 months with an average of(21.5±10.1)months.Among them,lymph node metastasis were seen in 17/25 patients.lymph node metastasis were found in 7/25 before surgery,and 1/25 found lymph node metastasis during surgery.Among the patients with distant metastases afterwards,multiple metastases throughout the body(4/14),lung metastases only(6/14),and bone metastases only(4/14),the 1-year survival rate was 88%(22/25),the 2-year survival rate was 40%(10/25),and the 3-year survival rate was 28%(7/25).Conclusions The diagnosis depends on histopathological examination.Early diagnosis may help improve prognosis.The first choice is a comprehensive treatment based on radical surgery.