表现不典型前列腺癌误诊原因探讨

Causes of Misdiagnosis of Atypical Prostate Cancer

目的探讨前列腺癌的不典型临床特点及影像学表现,分析发生误诊的原因及防范误诊措施。方法对2019年6月-2020年12月收治病初曾误诊的前列腺癌8例临床资料进行回顾性分析。结果本组均为男性,年龄51~68岁,有吸烟史5例,平素饮酒4例。以尿频、尿急、排尿不畅困难及腰骶髋部疼痛为主要表现就诊,其中肉眼血尿1例,腰背部疼痛2例。2例行X线检查示腰4椎体退行性变;8例直肠指诊或直肠超声检查示前列腺均有不同程度增生,大小29.7~65.5 ml。误诊为膀胱癌1例、前列腺增生4例、腰椎间盘突出症2例、骨质疏松症1例。经术后病理或前列腺穿刺活检确诊为前列腺癌累及膀胱1例、A期前列腺癌4例、前列腺癌骨转移3例。8例确诊后,予手术、内分泌、放疗等综合治疗,术后随访至今均存活,预后尚可。结论前列腺癌发病较隐匿,进展缓慢,早期临床及影像学表现不典型,较易漏误诊。加强对前列腺癌的了解,提高警惕性,重视血前列腺特异性抗原筛查及直肠指诊,合理选择特异性影像学检查项目,必要时行前列腺穿刺活检,并增加穿刺点和穿刺次数以提高穿刺活检阳性检出率,可以减少前列腺癌误诊的发生。

Objective To investigate the atypical clinical characteristics and imaging manifestations of prostate cancer,and to analyze the causes of misdiagnosis and preventive measures to avoid misdiagnosis.Methods Clinical data of 8 patients with prostate cancer who had been misdiagnosed at the beginning of treatment from June 2019 to December 2020 were retrospectively analyzed.Results All the subjects were males,aged 51-68 years,with smoking history in 5 cases and history of drinking alcohol in 4 cases.Frequent urination,urgent urination,difficulty in urination,and lumbosacral and hip pain were the main manifestations,including 1 case of gross hematuria and 2 cases of lumbar and back pain.Two patients underwent X-ray examination and showed degeneration of lumbar vertebra 4.Eight cases underwent digital rectal examination or rectal ultrasound,which showed different degrees of prostate hyperplasia,with the size of 29.7-65.5 ml.There was misdiagnosis as bladder cancer in 1 case,prostatic hyperplasia in 4 cases,lumbar disc herniation in 2 cases and osteoporosis in 1 case.Postoperative pathology or prostate biopsy confirmed prostate cancer involving bladder in 1 case,stage A prostate cancer in 4 cases,and bone metastasis of prostate cancer in 3 cases.After diagnosis,8 patients received comprehensive treatment such as surgery,endocrinology,and radiotherapy.All of them survived after postoperative follow-up,and the prognosis was fair.Conclusion Prostate cancer has insidious onset and develops slowly,and the early clinical and imaging manifestations are not typical,which leads to missed diagnosis or misdiagnosis.The misdiagnosis of prostate cancer can be reduced by strengthening the understanding of prostate cancer,increasing vigilance,attaching importance to blood prostate specific antigen screening and digital rectal examination,rationally selecting specific imaging items,performing prostate puncture biopsy when necessary,and improving the positive detection rate of puncture biopsy by increasing puncture sites and times.