病理复查并前列腺癌根治术后早期前列腺特异抗原监测的临床意义

目的：结合病理复查结果，监测前列腺癌根治术后早期的前列腺特异抗原(PSA)水平，指导术后的进一步治疗。方法：对25例前列腺癌根治术患者于术后1、2、4周时测定PSA水平，尔后每个月测定一次，随访5～17个月，平均11个月；并对术后标本的手术切缘及包膜浸润程度行病理复查。结果：病理报告T1～T2期17例，15例获根治，PSA水平均降至0．2μg／L以下，随访12个月无复发；2例PSA一直未降至正常，2个月后复升高而加用辅助治疗，其病理观察发现手术切缘有肿瘤残留。T3a或T3b期8例，4例获根治，PSA在3个月内降至0．2μg／L以下，随访9个月无复发，病理特征为肿瘤浸润包膜但未穿透；4例在1个月后因PSA回升分别加用辅助治疗，病理示肿瘤均穿透包膜。结论：T1～T2期患者，因手术切缘残留等原因，肿瘤可能早期复发；T3期患者，特别是那些侵犯包膜但未穿透者，手术可能达到根治，并可以延迟应用雄激素阻断治疗，延长治疗的有效时间。

Clinical significance of early detection of PSA levels after radical prostatectomy

Purpose:To observe serum PSA changes after radical prostatectomy to guide the next step therapy. Methods:PSA values of 28 patients were measured at 1 week, 2 week, 4 week and then at every month respectively after radical prostatectomy.All cases were followed up,the median is 11 months. Results:Among 17 patients of stages T 1-T 2,15 were cured biochemically and 2 received medicines for androgen blockage because of elevated PSA levels 2 months after radical prostatectomy.Of 8 cases of stage T 3a or T 3b ,4 were cured biochemically during the following period.Conclusions:Stages T 1-T 2 patients of prostate carcinoma can reoccur probably due to positive margin and patients of stage T 3 can also have the chance to be cured,especially for carcinoma invading into ,but not through prostate capsule.