湖南部分地区2877例前列腺癌患者临床流行病学特征及流行学趋势分析

目的:分析湖南部分地区前列腺癌患者流行病学特征,为防控策略的制定提供参考。方法:收集2010年1月1日～2019年12月31日就诊中南大学湘雅医院、湖南中医药大学第一附属医院、湖南中医药研究院附属医院的2 877例前列腺癌患者年龄、病理类型和中医证型资料,分析探讨前列腺癌发病现状及流行趋势。结果:2010年291例,2011年315例,2012年213例,2013年220例,2014年159例,2015年226例,2016年199例,2017年180例,2018年577例,2019年497例。患病人群年龄资料显示:40岁以下罕见,65～79岁呈高发病率。年龄组变化趋势为:65～79岁年龄组发病比例逐年增加,10年间增加至63.9%;80岁及以上组发病上升更明显,10年间增长率达到97.9%。病理分型中主要为腺癌。腺癌1441例(50.1%),腺泡细胞腺癌例201例(7.00%);滤泡状腺癌37例(1.29%),前列腺导管癌27例(0.94%),病例未特指273例(9.49%),其他腺癌166例(5.77%)。其中157例患者进行了中医辨证分型,主要为肾虚证型,其中肾阴虚者40例(25.5%),肾阳虚69例(43.9%)。结论:2010～2019年湖南地区前列腺癌发病呈老龄化趋势,65～69岁为发病峰值,65～79老年男性为高危人群,需加强健康宣教和早诊早治工作,降低其发病率。     

非典型钙黏素1与食管鳞癌临床病理特征及预后的关系

目的:探讨非典型钙黏素1（FAT1）与食管鳞癌临床病理特征及预后的关系。方法:采用回顾性队列研究方法。收集2011年1月至2015年12月山西省肿瘤医院收治的124例食管鳞癌病人的临床病理资料;男85例,女39例;中位年龄为60岁,年龄范围为40~72岁。收集手术切除食管鳞癌组织及癌旁组织标本,制备组织芯片,行免疫组织...     

肾上腺转移癌的血管造影与动脉药物栓塞治疗

1999至2002年我院采用介入技术治疗肾上腺转移癌患者8例,疗效满意,现报告如下. 对象与方法 本组8例.男6例,女2例.年龄39～69岁,平均62岁.右侧4例、左侧2例、双侧2例.8例原发癌均经病理证实,肺癌6例,其中小细胞癌2例、鳞癌2例、腺癌2例,肝细胞癌1例,肾透明细胞癌1例.     

胆囊腺鳞癌4例临床分析

目的:总结胆囊原发性腺鳞癌的临床病理特点及诊治经验。方法:回顾性分析1998年―2012年收治的4例胆囊腺鳞癌患者的临床资料。结果:4例患者中,3例行根治性手术,1例行姑息性手术;术后病理结果显示,癌组织中含有腺癌和鳞癌两种成分,CK8/18及CK5/64阳性;4例患者均于术后1年内死亡,中位生存期为180 d,均死于肿瘤复发或转移。结论:胆囊腺鳞癌非常罕见、恶性程度高、临床表现缺乏特异性,发现时分期已较晚;目前尚无有效的治疗方法,手术仍是目前主要的治疗手段,与胆囊腺癌相比总体预后较差。     

原发性胆囊癌(附39例报告)

本文报告12年来我院收治的39例经手术及病理证实原发性胆囊癌。腺癌30例、腺瘤癌变3例、硬化性腺癌1例、透明细胞癌1例、印戒细胞癌1例、粘液腺癌1例、磷状细胞癌2例。本组男16例,女23例,年龄30～78岁,中位年龄65岁,均有胆道病史。结石合并率为51.3％(20/39),术前诊断率为43.5％(17/89)。胆囊切除率61.5％(24/39)。作者讨论了胆囊癌发病的相关因素,并建议对有癌危因素的胆囊息肉样病变应积极予以胆囊切除。强调术中对胆囊大体标本检查的必要性。     

72例女性乳腺癌病理学分析

目的对女性乳腺癌的病理学特点进行分析,提高乳腺癌的正确诊断率。方法收集72例女性乳腺癌患者的病理学资料,回顾性分析其病理学特点。结果 72例女性乳腺癌患者的年龄41~66岁。其中导管内原位癌8例,小叶原位癌4例,髓样癌6例,黏液腺癌2例,浸润性小叶癌12例,浸润性导管癌39例,类癌1例。病理组织分型以浸润性导管癌为多,淋巴结转移情况与肿瘤大小成正相关性。结论乳腺癌是女性最常见的恶性肿瘤,临床病理分型与年龄及淋巴结增大等有密切关系,早诊断、早治疗可提高临床治愈率,对预后生活起到积极作用。     

吉西他滨联合顺铂治疗晚期非小细胞肺癌毒性反应的护理

我科于2010年5月至2012年3月采用吉西他滨联合顺铂治疗晚期非小细胞肺癌的化疗方案,治疗恶性肿瘤病人28例,收到明显的疗效,现将治疗过程中主要不良反应的治疗及护理对策报告如下: 1 资料和方法 1.1 一般资料:本组28例,均为经病理组织学或细胞学检查证实为晚期非小细胞肺癌的病人,男18例,女10例;年龄28～65岁,平均48.5岁;病理分型为腺癌19例,鳞癌7例,腺鳞2癌例;TNM分期:ⅢA期12例,ⅢB10例,Ⅳ期6例.     

胃癌根治术中食管切缘跳跃转移30例临床特征分析

目的总结分析胃癌根治术中食管切缘跳跃转移病例的临床特征。方法采用描述性病例系列研究的方法, 收集2006—2022年期间南京大学医学院附属鼓楼医院和东部战区总医院两家大型胃癌诊治中心的病例资料, 总结分析患者的肿瘤特征和手术情况以及肿瘤的免疫组织化学检测特点及病理分期, 并进一步分析食管侧吻合圈残留癌的细胞及组织层面分布特点。食管切缘跳跃转移定义为食管切缘阴性、但食管侧吻合圈阳性。结果双中心共有30例(0.33%, 30/8 972)胃癌患者根治术中发现食管切缘跳跃转移, 其中男性24例(80.0%), 年龄(63.9±11.0)岁。乳头状或管状腺癌17例(56.7%), 其中低分化13例(43.3%), 中分化4例(13.3%);印戒细胞癌4例(13.3%);黏液腺癌4例(13.3%);混合性腺癌3例(10.0%), 其中2例为低分化管状腺癌混杂印戒细胞癌及黏液腺癌, 1例为低分化管状腺癌混杂印戒细胞癌;特殊类型癌2例(6.7%), 其中1例为腺鳞癌, 1例为未分化癌。肿瘤位于胃小弯侧26例(86.7%), 位于贲门24例(80.0%)。肿瘤长径中位数6.6 cm, 距食管切缘中位数...     

根治性膀胱切除术中前列腺偶发癌的发病率及其对预后的影响

目的:探讨根治性膀胱前列腺切除术(RCP)治疗膀胱癌病例中前列腺偶发癌的发生率、病理特点及其对预后的影响。方法:回顾性分析2005年1月~2017年1月行RCP的178例患者的临床资料,年龄42~90岁,平均68岁。所有患者术前均未发现前列腺癌。结果:178例患者中,13例(7.3%)术后病理诊断为前列腺偶发癌,病理类型均为前列腺腺癌,5例(38.5%)前列腺偶发癌具有临床意义。前列腺癌TNM分期pT_1期3例,pT_2期8例,pT_3期2例。Gleason评分≤6分8例,Gleason评分7分3例,Gleason评分≥8分2例。前列腺偶发癌患者与未患前列腺偶发癌者术前前列腺特异性抗原(PSA)均值比较,差异无统计学意义(P0.05)。13例膀胱癌病理类型为尿路上皮癌,膀胱癌T_NM分期pT_1期4例,pT_2期3例,pT_3期3例,pT_4期3例。随访6~36个月,平均12个月,无前列腺癌死亡病例。结论:膀胱癌患者中前列腺偶发癌发生率较低,膀胱癌伴发前列腺偶发癌短期预后并不差于单纯膀胱癌。     

脐尿管癌17例临床分析

目的分析脐尿管癌的临床病理特征及预后特点。方法回顾性分析2011年8月至2017年2月我院收治的17例脐尿管癌患者的临床资料,其中男13例,女4例。年龄30~90岁,中位年龄52岁。结果 13例患者术前行血清肿瘤标志物检测,癌胚抗原(CEA)、糖类抗原19-9(CA19-9)及糖类抗原125(CA125)阳性率分别为46%、54%及31%。17例均行扩大的膀胱部分切除术,其中2例同期行盆腔淋巴结清扫术,1例因侵犯回肠行部分回肠切除术,1例合并左肾占位分期行左肾癌根治术。开放手术11例,腹腔镜手术5例,达芬奇机器人辅助腹腔镜手术1例。术后病理示黏液腺癌7例,中分化腺癌6例,低分化腺癌1例,尿路上皮癌伴腺样分化1例,未分型2例。7例患者接受化疗。中位随访时间22(3~66)个月,1年及5年生存率分别为77.8%、38.9%。结论脐尿管癌起病隐匿,发现时多为局部晚期,预后差,扩大的膀胱部分切除术为主要治疗方法,结合化疗或靶向治疗可能会改善预后。     

Sarcomatoid carcinoma of the prostate: a study of 42 cases

Sarcomatoid carcinoma of the prostate is a rare type of prostatic cancer. With the exception of 1 study, the morphologic features and patient outcomes have been reported only in relatively small case series and individual reports. We examined transurethral resection, needle biopsy, and radical prostatectomy specimens from 42 patients with sarcomatoid carcinoma of the prostate, all of which were received in consultation. Clinical information on 32 patients was obtainable. Five patients were lost to follow-up and information on the 5 remaining patients could not be obtained. Prior prostatic adenocarcinoma: The majority of patients (n=21; 66%) had a prior history of acinar adenocarcinoma of the prostate. Of the 14 men with available data, reported Gleason scores were 6 (n=7), 8 (n=4), and 10 (n=3). Of the remaining patients for whom this information was known, 11 patients presented with de novo sarcomatoid carcinoma. The time between the original diagnosis of acinar adenocarcinoma and diagnosis of sarcomatoid carcinoma ranged from 6 months to 16 years (mean 6.8 y). Concurrent adenocarcinoma: The majority of patients demonstrated a concurrent high grade acinar carcinoma of Gleason score 7 (n=3), 8 (n=9), 9 (n=10), and 10 (n=10). A subset of patients contained an admixed ductal adenocarcinoma (n=4), small cell carcinoma (n=3), squamous cell carcinoma (n=3), or other unusual pattern of prostate carcinoma (n=3). In 1 case, the diagnosis was based on immunohistochemical evidence of epithelial differentiation along with the history of prior adenocarcinoma. Morphology of the sarcomatoid component: The percentage of sarcomatoid growth ranged from 5% to 99% (mean 65%). Bizarre atypia with giant cells was present in 55% of cases. Admixed heterologous elements were identified in 10 cases (29%), including osteosarcomatous (n=7), chondrosarcomatous (n=5), and rhabdomyosarcomatous (n=2) elements. Of the 12 cases with received immunostains of the sarcomatoid component, 5/7 cases were at least focally positive for cytokeratin, 1/1 case was focally positive for Cam5.2, and 3/6 cases were focally positive for prostate acid phosphatase. The sarcomatoid component did not demonstrate immunoreactivity for prostate-specific antigen in 8 cases. Prognosis: approximately half of all patients developed metastatic disease either at time of presentation or subsequently. Of patients with meaningful follow-up, 6/7 died within 1 year of the diagnosis of sarcomatoid carcinoma; 20 were alive yet with very short follow-up (median 1 y; mean 2.3 y). Kaplan-Meier analysis revealed that the actuarial risk of death at 1 year after diagnosis of sarcomatoid carcinoma was 20%. No correlation was identified between patient survival and morphologic features, before radiation or hormone therapy, or concurrent high-grade prostate cancer. Sarcomatoid carcinoma demonstrates diverse spindle and epithelial cell morphologies. The sarcomatoid component often has heterologous elements and, in 1 case, no epithelial component was seen on hematoxylin and eosin-stained sections. The epithelial component is typically high-grade acinar adenocarcinoma, yet other aggressive tumor subtypes such as ductal adenocarcinoma and small cell carcinoma may also be seen. Sarcomatoid carcinoma is an aggressive form of prostate cancer, the prognosis of which is dismal regardless of other histologic or clinical findings.     

无功能性肾上腺肿瘤的诊断与治疗(附39例报告)

目的：提高无功能性肾上腺肿瘤的诊治水平。方法：回顾性分析我院17年来39例无功能性肾上腺肿瘤患者的临床资料。结果：39例中,38例行肿瘤切除或剜除术,1例仅行活组织检查;30例病理检查证实为良性无功能性肾上腺肿瘤,其中节细胞神经瘤7例,平滑肌瘤1例,皮质腺瘤10例,髓脂瘤3例,神经鞘瘤1例．肾上腺囊肿8例。随访6个月～7年,临床症状消失,无肿瘤复发。9例病理检查证实为恶性无功能性肾上腺肿瘤,其中脂肪肉瘤1例,皮质腺癌4例,转移癌4例,术后2年内,8例死亡,1例无癌生存14个月。结论：无功能性肾上腺肿瘤临床少见,早期诊断困难,CT是首选检查方法,确诊依赖于病理检查。手术切除是良性肿瘤的有效手段,但对恶性肿瘤预后较差。     

Clinical features of prostate cancer patients younger than 50 years: Report of seven cases

BACKGROUND: The incidence of prostate cancer increases with age and latent cancer is common in older men. But clinical prostate cancer is rare in men aged < 50 years. METHODS: Between 1988 and 2000, we studied seven cases of prostate cancer in men aged under 50 years. The clinicopathological results included: the first sign or symptom; prostate-specific antigen (PSA) at the time of diagnosis; existence of abnormal digital rectal examination (DRE); the differentiation of the cancer and Gleason score; and the outcome of treatment. RESULTS: Six cases were diagnosed as stage D2. One case was diagnosed as stage B2 and the patient underwent radical prostatectomy. None of the cases were detected by mass screening. The PSA at diagnosis was < 10 ng/mL in only one case and that patient underwent radical prostatectomy. Six cases were diagnosed pathologically as poorly differentiated adenocarcinoma. The only patient who survived more than 5 years underwent radical prostatectomy. CONCLUSION: Six of seven cases of prostate cancer were detected at advanced stage. Only one case was thought to be curable and this patient's cancer was detected by chance occult blood test. Because young prostate cancer patients are potential candidates for radical prostatectomy and the sensitivity of PSA might be higher in young men, high-risk groups could be screened by PSA.     

Early prostate cancer antigen expression in predicting presence of prostate cancer in men with histologically negative biopsies

PURPOSE: Early prostate cancer antigen is a nuclear matrix protein that was recently shown to be expressed in prostate adenocarcinoma and adjacent benign tissue. Previous studies have demonstrated early prostate cancer antigen expression in benign prostate tissue up to 5 years before a diagnosis of prostate carcinoma, suggesting that early prostate cancer antigen could be used as a potential predictive marker. MATERIALS AND METHODS: We evaluated early prostate cancer antigen expression by immunohistochemistry using a polyclonal antibody (Onconome Inc., Seattle, Washington) on benign biopsies from 98 patients. Biopsies were obtained from 4 groups that included 39 patients with first time negative biopsy (group 1), 24 patients with persistently negative biopsies (group 2), 8 patients with initially negative biopsies who were subsequently diagnosed with prostate carcinoma (group 3) and negative biopsies obtained from 27 cases where other concurrent biopsies contained prostate carcinoma (group 4). Early prostate cancer antigen staining was assessed by 2 of the authors who were blind to the group of the examined sections. Staining intensity (range 0 to 3) and extent (range 1 to 3) scores were assigned. The presence of intensity 3 staining in any of the blocks of a biopsy specimen was considered as positive for early prostate cancer antigen for the primary outcome in the statistical analysis. In addition, as secondary outcomes we evaluated the data using the proportion of blocks with intensity 3 early prostate cancer antigen staining, the mean of the product of staining intensity and staining extent of all blocks within a biopsy, and the mean of the product of intensity 3 staining and extent. RESULTS: Primary outcome analysis revealed the proportion of early prostate cancer antigen positivity to be highest in group 3 (6 of 8, 75%) and lowest in group 2 (7 of 24, 29%, p=0.04 for differences among groups). A relatively higher than expected proportion of early prostate cancer antigen positivity was present in group 1 (23 of 39, 59%). Early prostate cancer antigen was negative in 41% of group 4 who were known to harbor prostate carcinoma. The proportion of early prostate cancer antigen positivity was statistically significantly lower in group 2 than in each of the other groups when compared pairwise. A lower proportion of early prostate cancer antigen positivity was encountered in older archival tissue blocks (p<0.0001) pointing to a potential confounding factor. Corrected for block age, group 3 was the only group to remain statistically significantly different in early prostate cancer antigen positivity compared to the reference group 2. Similar findings were obtained when adjustments for patient age were made and when analysis was based on secondary outcome measurements. CONCLUSIONS: Our study showed a higher proportion of early prostate cancer antigen expression in initial negative prostate biopsy of patients who were diagnosed with prostate carcinoma on subsequent followup biopsies. We found a relatively high proportion of early prostate cancer antigen positivity (59%) in the group with first time negative biopsies and a potential 41% rate of false-negative early prostate cancer antigen staining in benign biopsies from cases with documented prostate carcinoma on concurrent cores. The lower early prostate cancer antigen positivity in cases with older blocks raises the question of a confounding effect of block age. Additional studies on the antigenic properties of early prostate cancer antigen in archival material are required to further delineate the usefulness of early prostate cancer antigen immunostaining on biopsy material.     

偶发性前列腺癌的临床病理学研究

目的:探讨偶发性前列腺癌的临床病理特征及预后.方法:回顾性分析580例膀胱癌根治术中96例偶发前列腺癌的临床资料及病理学特征,并进行预后随访.结果:偶发前列腺癌的发生率为16.6％(96/580).年龄42～90岁,中位年龄为73岁;其中≤60岁6例(6.2％),＞60岁90例(93.8％).肿瘤平均最大直径约3.5 ...     

经直肠超声引导穿刺活检诊断早期前列腺癌漏诊原因的分析

目的:分析经直肠超声(TRUS)引导下穿刺活检诊断前列腺癌的漏诊原因,减少漏诊率,提高诊断率。方法:80例疑似前列腺癌的良性前列腺增生(BPH)患者行TRUS引导下穿刺活检,结果均为阴性,均行前列腺电切术(TURP),术后标本行病理检查。结果:25例术后病理报告为前列腺癌,漏诊率31.25%(25/80)。其中10例行经会阴前列腺癌根治术、8例行手术去势、7例行药物去势。结论:TRUS引导穿刺活检诊断前列腺癌存在一定的漏诊,多次或多点穿刺活检可以减少漏诊率。     

Diffuse adenosis of the peripheral zone in prostate needle biopsy and prostatectomy specimens

We have observed a group of typically younger patients with multiple foci of small, nonlobular, crowded, but relatively bland acini on needle biopsy and in prostatectomy specimens. It is unclear whether this architectural pattern, which we have termed diffuse adenosis of the peripheral zone (DAPZ), is simply a crowded glandular variant of normal prostate morphology or whether it represents a risk factor for the development of prostatic carcinoma. We studied 60 cases of DAPZ on needle biopsy in our consult practice from 2001 to 2007. Cases, on average, showed 72% of cores involved by DAPZ. Average patient age was 49 years (range: 34 to 73) and the average prostate specific antigen (PSA) level at the time of biopsy was 5.2 ng/mL (n=42). Forty-three (72%) men had available clinical follow-up with 35 (81%) patients undergoing rebiopsy and 8 (19%) followed with serial PSA measurements. Patients who were rebiopsied after DAPZ diagnosis had higher PSA levels than those who were followed by PSA levels alone (6.2 vs. 3.1 ng/mL, P=0.04). Of the rebiopsied cases, 20 (57%) were subsequently diagnosed with carcinoma, with an average of 15 months elapsed between initial biopsy and carcinoma diagnosis. Although the majority of tissue sampled in a typical DAPZ case had no cytologic atypia, in 65% of cases there were admixed rare foci of atypical glands with prominent nucleoli comprising <1% of submitted tissue. Patients with a subsequent diagnosis of carcinoma were more likely to have had DAPZ with focal atypia, although this did not reach statistical significance (70% vs. 36%, P=0.08). We histologically confirmed the carcinoma diagnosis in 18/20 cases. In 12/14 radical prostatectomies, we were able to review the slides. Eleven had Gleason score 3+3=6 adenocarcinoma in addition to background DAPZ; 9 showed peripheral zone organ-confined cancer, and 2 had focal extraprostatic extension. In one case of DAPZ misdiagnosed as cancer on biopsy, no carcinoma was found at prostatectomy. DAPZ is a newly described and diagnostically challenging mimicker of prostate cancer seen in prostate needle biopsies from typically younger patients. Our findings suggest that DAPZ should be considered a risk factor for prostate cancer and that patients with this finding should be followed closely and rebiopsied.     

Small cell carcinoma of the prostate: a report of three patients and a prognostic analysis of cases reported in Japan

Small cell carcinoma (SCC) originating from the prostate is rare. We report three cases of SCC of the prostate. Case 1: A 29-year-old man with large pelvic mass and pelvic lymph node metastases was diagnosed as having pure SCC of the prostate. Chemo-radiotherapy resulted in a great reduction of the tumor volume. However, the disease recurred immediately, and he died of disease 17 months after diagnosis. Case 2: A 65-year-old man presented with pure prostatic SCC with lung metastases. Although cystoprostatectomy combined with pre- and post-operative chemotherapy ended with no evidence of disease, he died after 16 months because of multiple metastases and local recurrence. Case 3: A 73-year-old man was diagnosed as having SCC and poorly differentiated adenocarcinoma of the prostate simultaneously. Chemo-endocrine therapy and pelvic irradiation were performed, achieving partial remission. However, he developed multiple distant metastases, and died of disease 15 months after diagnosis. We reviewed 82 cases previously reported in Japan. Patient's ages ranged from 24 to 86 years (mean 68.7 years). Many patients had lymph node or distant metastases (stage D, 73%). Thirty-seven (45%) were pure SCCs and 45 (55%) were associated with adenocarcinoma. The prognosis after the recognition of SCC is very poor, and the 1- and 2-year survival rates were 27% and 10%, respectively. Survival did not differ in patients with pure SCC or mixed glandular and small cell carcinoma. Higher elevation of pretreatment serum NSE value was associated with the poor prognosis.     

膀胱非尿路上皮性肿瘤的诊治(附46例报告)

目的:探讨膀胱非尿路上皮性肿瘤的诊断、治疗方法和预后。方法:回顾性分析2002年1月～2010年12月收治的46例膀胱非尿路上皮性肿瘤患者的临床资料:男34例,女12例。年龄30～82岁,平均61.3岁。术前辅助检查主要包括B超、盆腔CT、膀胱镜加病理活检以及131I-MIBG。42例行手术治疗,4例放弃手术。结果:46例术前或术后病理检查诊断为膀胱鳞状细胞癌19例,膀胱腺癌18例(单纯性非脐尿管腺癌8例,脐尿管腺癌5例,转移性腺癌5例),膀胱小细胞癌4例,膀胱嗜铬细胞瘤5例。术后40例随访12～72个月,膀胱嗜铬细胞瘤5例均健在,膀胱鳞癌及腺癌各2例随访至14～26个月仍存活,其余患者平均存活时间13.2个月。结论:膀胱非尿路上皮恶性肿瘤恶性程度高,确诊时大多已是晚期,预后差。膀胱根治性切除术是除转移性癌和小细胞癌外的膀胱非尿路上皮性恶性肿瘤的推荐手术方案,小细胞癌以化疗为主,转移性癌以改善尿路症状为主,良性嗜铬细胞瘤以膀胱部分切除为主。     

Prevalence of prostate specific antigen testing for prostate cancer in elderly men

PURPOSE: We investigated the prevalence and outcome of PSA testing for prostate cancer screening or diagnosis in elderly men 75 years or older at our academic medical center. MATERIALS AND METHODS: A cross-sectional study design was used to identify all men 75 years or older who underwent a PSA test through the family medicine or internal medicine service at our institution between January 1, 1998 and June 30, 2004. All patients with a suspected (PSA less than 0.1 ng/ml) or confirmed prior diagnosis of prostate cancer were excluded. The prevalence of PSA testing was then compared to that in younger age groups (45 to 54, 55 to 64 and 65 to 74 years). We then examined the frequency and nature of further evaluation and treatment performed in men following the PSA test. RESULTS: The 8,787 male patients who were 75 years or older generated a total of 82,672 visits in the 5.5-year period. Of these patients 505 (5.7%) underwent at least 1 PSA test. The prevalence of PSA testing in the younger age groups was 10.3% (1,769 of 17,175) in patients 45 to 54 years old, 14.9% (2,052 of 13,772) in those 55 to 64 years old and 11.8% (1,258 of 10,661) in those 65 to 74 years old (chi-square test p <0.001). Of these patients 98 of 343 (28.6%) with PSA between 0.1 and 4 ng/ml were referred to a urologist at our institution and 3 underwent biopsy. None had a prostate cancer diagnosis. Of the 162 patients with PSA more than 4 ng/ml 84 (51.9%) were referred to a urologist. Only 10 of the 84 patients (11.9%) who were referred to a urologist underwent prostate biopsy. Six of the 10 men (60%) were diagnosed with prostate cancer, including 1 with a Gleason 6 tumor, 1 with a Gleason 7 tumor and 4 who were found to have tumors with a Gleason score of 8 or greater. All patients received androgen deprivation therapy, except 1 who received local external beam radiation therapy. An additional patient was diagnosed by biopsy of a vertebral lesion and he received hormone therapy. At a median followup of 51 months (range 28 to 72) 4 of 7 men (57%) were alive with disease. CONCLUSIONS: PSA testing for prostate cancer screening and diagnosis appear to decrease with advancing age. A small but significant proportion of men who are 75 years or older continue to undergo PSA testing. Abnormal PSA results do not always result in further evaluation and therapy for prostate cancer in elderly men. The establishment of firm guideline recommendations regarding PSA testing and further evaluation for prostate cancer in elderly men, perhaps based on individualized geriatric assessment, may be helpful.