偶发性前列腺癌23例诊治分析

目的 提高偶发性前列腺癌的诊断和治疗水平。方法 回顾性分析1996年1月-2004年9月收治23例偶发性前列腺癌病例临床资料。病理报告前列腺腺癌18例，未分化癌5例。A1期16例，A2期7例。17例行双侧睾丸切除术，4例行根治性前列腺癌手术，2例内分泌治疗。结果 22例获随访9月至8年，A1期15例中11例无瘤存活，A2期7例中3例无瘤存活。结论 偶发性前列腺癌预后与分期有关，应积极治疗，疗效满意。     

良性前列腺增生术后前列腺偶发癌10年回顾性分析

目的　分析良性前列腺增生 (BPH)术后前列腺偶发癌的特点、治疗方法和随访结果。　方法　回顾性分析 1994 - 2 0 0 3年因BPH行TURP或前列腺摘除术 15 11例资料。发现前列腺偶发癌 35例 ,年龄 6 3～ 82岁。腺癌 34例 ,T1a17例 ,T1b17例 ;前列腺移行细胞癌 1例。行内分泌治疗11例 ,观察等待 2 4例。　结果　 33例随访 8～ 10 7个月 (5 5 .2± 2 8.6 ) ,失访 2例。治疗组 8例存活 ,死亡 2例 (因心血管病死亡 1例 ) ,失访 1例 ;观察组 2 1例存活 ,死亡 2例 ,失访 1例。T1a或T1b期观察等待患者的肿瘤特异性生存率之间差异无统计学意义 (P =0 .4 80 ) ;T1b期患者 ,观察等待与内分泌治疗患者的肿瘤特异性生存率之间差异无统计学意义 (P =0 .5 2 7)。　结论　PSA应用于临床后 ,BPH术后偶发癌的比例为 2 .3% ;对于偶发前列腺腺癌 ,可以观察等待。     

TUPVP术后前列腺偶发癌的诊治(附15例报告)

目的 :探讨经尿道前列腺等离子汽化切除术 (TUPVP)后前列腺偶发癌的诊断和治疗。　方法 :对 134例良性前列腺增生患者行TUPVP ,术后的组织标本采用连续切片法作常规病理检查。　结果 :134例TUPVP术后的前列腺标本中共检出前列腺癌 15例 ,检出率为 11.2 %。 4例A2 期患者行双侧睾丸切除术加内分泌治疗 ,9例A1期患者行内分泌治疗。除 2例术后没有任何治疗的患者失访外 ,其余 13例患者随访 7～ 15个月 ,全部存活 ,血清前列腺特异性抗原 (PSA)为 0 .15～ 4 .0 μg/L。 　结论 :TUPVP术对前列腺组织的破坏小 ,术后标本多部位连续病理切片 ,可提高前列腺偶发癌的检出率 ,A1期患者可仅行内分泌治疗 ,A2 期患者应加双侧睾丸切除。     

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。     

前列腺偶发癌的诊断和治疗（附18例报告）

目的：探讨前列腺偶发癌的诊断和治疗。方法：对217例前列腺增生症患者的前列腺标本采用连续切片方法进行常规病理检查。结果：152例经耻骨上前列腺切除术切除的标本中检出前列腺癌13例,经尿道前列腺切除术切除的标本中检出5例,总检出率8．29％。13例行睾丸切除术,5例行内分泌治疗,其中2例治疗1个月后自行停药。15例获得1－5年随访,其中2例死于肿瘤转移,1例死于心肺疾病,12例无瘤生存。结论：连续切片法有助于前列腺偶发癌的检出,治疗应根据个体情况综合考虑,手术以睾丸切除术较常用,术后应建立严格的随访制度。     

前列腺小细胞癌诊疗体会(附2例报告)

目的:探讨前列腺小细胞癌的临床表现、诊断方法、病理特征及治疗方法,以期提高对前列腺小细胞癌的进一步认识。方法:回顾性分析2017年11月至2018年3月收治的2例确诊前列腺小细胞癌的临床及病理资料,并复习相关文献。结果:2例患者均有排尿困难症状,PSA均有升高,前列腺触诊有II°～III°增大,其中1例行前列腺穿刺活检,1例行经尿道前列腺部肿瘤1470激光汽化切除术。术后病理均提示前列腺腺癌伴前列腺小细胞癌,1例患者行EP方案化疗,于确诊20个月后死于全身多器官功能衰竭;1例患者行内分泌治疗,目前带瘤存活。结论:前列腺小细胞癌发病率低,恶性程度高。确诊后平均生存期约7～10个月,目前仍无可靠治疗方案,现基本参照肺小细胞癌的治疗经验,仍以化疗为主,该病预后较差,治疗效果多不满意。     

膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

5O岁以下前列腺癌11例报告并文献复习

目的：探讨50岁以下前列腺癌（PCa）的诊断、治疗及预后情况。方法：分析11例50岁以下PCa患者的发病年龄、主要症状、前列腺特异性抗原（PSA）,病理诊断、治疗方法、预后情况,并进行文献资料复习。结果：11例患者平均年龄45．6岁,平均PSA22．3”g／L,平均Gleason评分为7．7分。资料完整患者9例,1例骨扫描提示全身多发骨转移,8例未见转移灶;临床分期T。期3例,Tz期5例,Ts期1例。随访9例,1例行内分泌治疗1．5年后去世,1例经尿道前列腺切除术（TURP）后偶发癌观察等待,7例行前列腺癌根治术患者平均随访4年,3例生化复发,其余4例无生化和临床复发。结论：应提高对50岁以下PCa的警惕性,PSA检查有助于早期诊断,前列腺癌根治术对无远处转移的患者具有良好的治疗效果。     

前列腺偶发癌9例报告

１９８９￣１９９３年共行开放手术治疗良性前列腺增生（ＢＰＨ）２５６例，病理发现前列腺腺癌９例，检出率３．５２％。其中Ａ１期３例，Ａ２期６例。对偶发癌发病率、ＢＰＨ与偶发癌、临床癌的关系以及治疗、预后进行分析，结果表明，发病率与手术和病理检查方法有关；偶发癌与ＢＰＨ同源，是ＢＰＨ腺体的局部恶变，部分临床癌是偶发癌恶化的结果。     

50岁以下前列腺癌11例报告并文献复习

目的:探讨50岁以下前列腺癌(PCa)的诊断、治疗及预后情况。方法:分析11例50岁以下PCa患者的发病年龄、主要症状、前列腺特异性抗原(PSA),病理诊断、治疗方法、预后情况,并进行文献资料复习。结果:11例患者平均年龄45.6岁,平均PSA 22.3μg/L,平均Gleason评分为7.7分。资料完整患者9例,1例骨扫描提示全身多发骨转移,8例未见转移灶;临床分期T1期3例,T2期5例,T3期1例。随访9例,1例行内分泌治疗1.5年后去世,1例经尿道前列腺切除术(TURP)后偶发癌观察等待,7例行前列腺癌根治术患者平均随访4年,3例生化复发,其余4例无生化和临床复发。结论:应提高对50岁以下PCa的警惕性,PSA检查有助于早期诊断,前列腺癌根治术对无远处转移的患者具有良好的治疗效果。     

前列腺增生的偶发癌：附10例报告

１９９０～１９９２年，从１０８例良性前列腺增生（ＢＰＨ）的手术标本中，连续病理切片检出前列腺偶发癌１０例，检出率为９．２５％。病理报告均为腺癌。其中低分化腺癌３例，分化较好或高分化７例。结合文献对前列腺偶发癌发生率，ＢＰＨ与前列腺癌关系，偶发癌的治疗及预后进行讨论。     

Study of incidental carcinoma of the prostate. II. Nuclear DNA analysis]

The clinical significance of cytofluorometric nuclear DNA analysis, ploidy pattern and DNA content, was investigated in 47 incidental prostatic carcinomas, 24 stage A1 and 23 stage A2 cases, 9 clinically advanced cases and 25 BPHs. The results were compared to clinical stage and histological differentiation. The mean nuclear DNA content of stage A1 cancer, which was similar to BPH, differed from that of stage A2 cases. The latter was almost identical to that of advanced cases. In moderately and poorly differentiated carcinomas it was higher than that of well differentiated ones. A non-diploid pattern was distributed in 33% of stage A1, 78% of stage A2 and 89% of clinically advanced cases. It was detected in 42% of the well-, 77% of the moderately- and 100% of the poorly differentiated adenocarcinomas. The DNA analysis of incidental prostatic cancer thus correlated well to the clinical and pathological parameters. If limited to well differentiated carcinomas, however, 17% of the stage A1 cases showed an aneuploid, and 29% of the stage A2 cases, a diploid pattern. No diploid pattern was detected in clinically advanced cases. Although we have not been able to prove any difference in prognosis in the present cases, these findings suggest that the nuclear DNA analysis is another parameter in defining the prognosis of incidental prostatic carcinoma. Further follow-up of the patients and accumulation of the data are necessary to determine the clinical validity of this method.     

前列腺偶发癌的再认识

前列腺偶发癌的生物学行为、自然病程及预后难以预测,对其治疗尚有不同看法。目前认为,对偶发癌患者要作进一步检查以再分期,而后按其准确的分期作必要的进一步治疗。本文简要概述有关前列腺偶发癌的定义及诊断标准、检出率、再分期方法及治疗。     

Study of incidental carcinoma of the prostate. Part 1. Pathological analysis related to the clinical features

To clarify the clinico-pathological characteristics of incidental carcinoma of the prostate, we investigated a total of 590 prostatic tissues which had been operated under the diagnosis of benign prostatic hyperplasia (BPH), including 12 whole prostatic specimens which were obtained by total cystectomy due to bladder cancer. Histological examination and estimation of the tumor volume were carried out by either a 3-mm step-section in 185 prostates obtained by open surgery, or by mounting whole specimens in 405 TUR cases. Incidental cancers were detected in 69 of the 590 patients (12%) with nearly equal numbers of stage A1 and stage A2 diseases. The age and the size of the prostate were significantly greater in the patients with cancer, compared to those without cancer. However, these parameters were not in agreement with each other. Histological analysis revealed that 46 of the 69 (67%) incidental cancers were well differentiated and nearly corresponded to Gleason's sum score of 2-4. In the analysis of the differentiation of the tumor cells and the tumor extension, nearly 80% of the 23 well differentiated cancers were manifest in a single lesion and were smaller than 0.3 cm3, whereas 90% of the 11 moderately or poorly differentiated cancers were diffusely invasive. Six of the 11 cases (55%) were larger than 0.3 cm3. The prognosis of the 16 incidental cancer patients who had survived more than 5 years after the surgery were compared with the controls. The controls were selected among the cases without incidental cancer, and matched for age and the time of operation in a 1 to 2 fashion without knowledge of their prognoses.(ABSTRACT TRUNCATED AT 250 WORDS)     

中药鸦胆子油乳治疗中、晚期前列腺癌

本文报道33例中、晚期前列腺癌采用中药鸦胆子油乳(以下称鸦油乳)注射疗法,对14例C期用鸦油乳腺体内注射+去势术(含2例未去势术)治疗,对19例D期采用鸦油乳腺体内注射和静肪内滴注+去势术(含4例未去势术)治疗后,近期疗效满意。C期14例达CR,D期3例达CR和16例达PR效果。与既往常用之单纯去势、内分泌治疗和放疗相比3年生存率高且无副作用。     

Galectin-3和CD44v6的表达与前列腺癌转移及预后的关系

目的：探讨Galectin-3和CD44v6蛋白表达与前列腺癌（PCa）临床病理特征和预后的关系。方法：应用免疫组织化学技术检测45例PCa、25例PIN和20例BPH组织中Galectin-3和CD44v6蛋白表达,并结合肿瘤的病理学行为和临床随访资料进行分析。结果：在PCa组织中,Galectin-3和CD44v6阳性表达率分别为（82．2±59．5）％、（75．6±24．0）％,均显著高于PIN和BPH组织（P〈0．05）。Galeetin-3和CD44v6表达与肿瘤分化程度、周围淋巴结转移、远处转移、预后密切相关（P〈0．05）。Galectin-3和CD44v6蛋白表达呈显著正相关（r=0．412,P==0．005）。结论：Galectin-3和CD44v6蛋白表达与PCa发生、转移和患者生存期密切相关,联合检测可以对PCa的发生、发展、预后及药物治疗提供重要依据。     

Ketoconazole therapy for hormonally refractive metastatic prostate cancer

Twenty-two patients who had progressive metastatic prostatic carcinoma (Stage D2) despite androgen-deprivation therapy (bilateral orchiectomy, 10 cases; bilateral orchiectomy followed by diethylstilbestrol, 7 cases; diethylstilbestrol, 3 cases; combined megestrol acetate and low-dose estrogen, 2 cases) were treated with ketoconazole. Of 19 evaluable patients, 2 (11%) achieved a partial response (for 6 and 8 months) and 7 others (37%) achieved stabilization of disease (for periods of 3-8 months). Of 16 patients in whom pain was a prominent clinical feature, 13 (81%) noted improvement in pain for periods of one to eight months (median 3 months). We conclude that ketoconazole is a useful addition to our current armory for management of patients with metastatic prostatic cancer resistant to prior hormonal therapy.     

鸦胆子油乳治疗中、晚期前列腺癌疗效观察(附33例报告)

为探讨治疗中、晚期前列腺癌（PCa）的有效方法，采用中药鸦胆子油乳注射疗法治疗中、晚期PCa33例，其中14例C期PCa采用鸦胆子油乳腺体内注射加卓九切除术（含2例未作睾丸切除术者）治疗，19例D期PCa采用鸦胆子油乳腺体内注射和静脉内滴注加睾丸切除术（含4例未作睾丸切除术者）治疗。结果2年内近期疗效满意，14例C期PCa达到完全缓解，19例D期PCa中有3例达到完全缓解，16例达到部分缓解。3年生存率达78．8％。认为，与既往常用的单纯睾丸切除内分泌治疗和放疗相比，鸦胆子油乳注射治疗中、晚期PCa患者的3年生存率高，且无副作用。     

Coincident vesical transitional cell carcinoma and prostatic carcinoma. Clinical features and treatment

Twenty-two patients with vesical urothelial carcinoma associated with prostatic carcinoma were reviewed. They represented 1.5% of the bladder and prostatic tumours treated in our department within a 12-year period from 1968 to 1979. Their management included several treatment policies, based on the separate assessment of each tumour variant. For non-infiltrating bladder tumours, transurethral tumour resection was combined with hormonal treatment, external radiotherapy or resection of the prostate depending on the stage of the prostatic tumour. Radical cystoprostatectomy was performed for two cases of infiltrating bladder tumour with well localised prostatic tumours. A conservative primary approach seems justifiable in the management of double carcinoma of the bladder and prostate. The coincidence of bladder urothelial carcinoma and prostatic carcinoma per se is not an adverse prognostic factor; prognosis is more closely related to the pathological stage and grade of the bladder tumour. Cystoprostatectomy for patients with infiltrating bladder tumours could be curative, in selected cases, for the prostatic cancer as well.