前列腺癌的诊断方法及其临床意义

为提高前列腺癌的早期诊断水平，对１９８５～１９９５年收治的３６例前列腺癌根据临床症状、直肠指检、Ｂ超、ＣＴ、ＭＲＩ、活检及瘤标检查等，分析其诊断价值。结果：临床症状中排尿不畅３３例（９１．６％），尿潴留１５例（４１．６％），血尿１２例（３３．３％），假性尿失禁、消瘦、阴囊水肿４例（１１．１％）；直肠指检可触及前列腺质地坚硬２８例（７７．７％），腺体表面高低不平１１例（３０．５％），单纯性结节２６例（７２．２％）。Ｂ超３４例，腺体增大凸入膀胱８例（２３．５％），内部强回声４例（１１．７％），低回声１２例（３５．２％），两侧叶不对称、伴高低不平１３例（３８．２％），浸润膀胱壁和三角区６例（１７．６％），侵犯双侧精囊和直肠壁３例（８．８％）；活检阳性２４例（９２．３％），ＰＳＡ检查２３例，均高于正常值。结果认为，临床症状、影像学检查及瘤标ＰＳＡ测定是诊断前列腺癌的重要依据。

Diagnostic means for prostatic cancer

The clinical manifestations,transrectal palpation,ultrasonography,CT scanning,MRI of prostate and blood PSA findings in 36 cases of prostatic cancer were evaluated retrospectively.As to the clinical manifestations,dysuria occurred in 33 (91.6%),retention of urine in 15 (41.6%) and hematuria in 12 (33.3%).Pseudo incontinence or scrotum edema was noticed in 4.On transrectal palpation,glandular induration was found in 28 (77.7%),irregularity of the prostate surface in 11 (30.5%) and elevated nodules in 26 (72.2%).Ultrasonography revealed a prostatic enlargement in 8 ( 23.5%),high echo in 4 (11.3%),low echo in 12 (35.2%),vesical infiltration in 6 (17.6%) and semical rectal wall invasion in 3 (8.8%).Positive prostate biopsy was found in 24 (92.3%)and elevated blood PSA.It was concluded that clinical manifestations together with the imaging and PSA findings were important in the early diagnosis of prostatic cancer.