血清前列腺特异抗原正常的前列腺癌6例报告及文献复习

Prostate cancer with normal serum PSA:a report of 6 cases and literature review

目的 分析6例术前前列腺特异抗原(PSA)处于正常水平的前列腺癌患者的临床资料,为进一步提高前列腺癌的诊断水平提供有价值的参考指标。方法 回顾性分析于我院行经会阴前列腺穿刺活检或经尿道前列腺手术病理确诊的6例前列腺癌患者的临床资料。分析总结其在年龄、临床表现、体质指数(BMI)、前列腺特异抗原密度(PSAD)、血甘油三酯、血胆固醇、彩超、磁共振、病理类型、Gleason评分的特点。结合文献总结PSA处于正常水平的前列腺癌患者的临床特点及高危因素。结果 2例前列腺穿刺病理确诊,4例前列腺电切术后病理确诊,3例血脂偏高,3例骨显像阴性,另外3例未查。PSAD 0.017~1.215。彩超提示形态不规整2例,回声不均匀2例,两者均有1例,所有6例均提示钙化。在行磁共振检查的3例中2例磁共振提示结节,多参数核磁共振的前列腺影像报告和数据评分系统(PIRADS) 4级;1例PIRADS 5级,并提示侵犯精囊腺、直肠、膀胱后壁、双侧神经血管束(NVB)增粗、盆腔淋巴结肿大。5例病理提示前列腺腺泡腺癌,其中4例Gleason评分3+3=6,1例5+5=10。1例提示高级别神经内分泌癌。结论 PSA正常水平前列腺癌临床检出率偏低,临床上要注意结合其特点及高危因素综合判断。

Objective To analyze the clinical data of prostate cancer patients with normal PSA level confirmed with transperineal prostate biopsy or transurethral prostate surgery, in order to improve the diagnostic level of this disease.Methods The clinical data of 6 patients were retrospectively analyzed.The age, clinical manifestations, body mass index(BMI),prostate specific antigen density(PSAD),blood triglycerides, blood cholesterol, color ultrasound imaging, magnetic resonance imaging(MRI),pathological types and Gleason scores were analyzed.The clinical characteristics and high-risk factors were summarized.Results Two cases were confirmed with prostate biopsy and four after prostate resection.Three patients had high blood triglycerides, three were negative for bone imaging, and the other three were not examined.PSAD was 0.017 to 1.215.Color ultrasound indicated that two cases had irregular morphology, two uneven echo, and one both irregular morphology and uneven echo;all six cases had calcification.In the three cases who received MRI,two had PIRADS4 nodules, one had PIRADS5 nodules, invasion of seminal vesicle, rectum, posterior wall of urinary bladder, bilateral thickening of NVB,and lymph nodes enlargement.Pathology suggested prostatic acinar adenocarcinoma in five cases, four of which had a Gleason score of 3+3=6 and one had 5+5=10;one case suggested a high-grade neuroendocrine carcinoma.Conclusion The clinical detection rate is low for prostate cancer with normal PSA.The biopsy indications should be determined by combining the characteristics and high-risk factors to improve the detection rate.