前列腺上皮内瘤诊治分析(附13例报告)

目的　探讨前列腺上皮内瘤 (PIN)的临床特征、诊断和处理。　方法　分析 13例PIN患者的临床资料。良性前列腺增生合并PIN 4例 (HGPIN 1例 ,LGPIN 3例 ) ,行TURP手术 3例 ,耻骨上经膀胱前列腺摘除术 1例 ;前列腺癌并发PIN 8例 (均为HGPIN) ,行前列腺根治性切除术 5例 ,TURP手术 3例 ;体检发现LGPIN 1例 ,因血PSA持续升高 ,TURP术后给予雄激素全阻断治疗。　结果　 13例均经病理确诊 ,血PSA检测、直肠指诊和经直肠B超等检查对PIN诊断无意义。 4例BPH合并PIN患者均健康存活 (3～ 5年 ) ,1例 1年后随访活检发现进展为前列腺癌 ,行前列腺根治性切除术 ;5例前列腺癌并发PIN患者随访 2～ 5年后健康存活 ,1例死于其它疾病 ,2例失访 ;体检发现者 3个月后血PSA明显下降。　结论　病理检查是诊断PIN的惟一方法。对PIN应进行雄激素全阻断治疗并密切随访 ,定期穿刺活检是早期发现PIN恶变的有效方法。     

HGPIN患者血清PSA特征及首次穿刺活检HGPIN阳性针数对再次活检PCa检出率的影响

目的 探讨高级别前列腺上皮内瘤(high grade prostatic intraepithelial neoplasia,HGPIN)患者血清前列腺特异性抗原(prostate specific antigen,PSA)特征及首次穿刺活检HGPIN阳性针数对再次活检前列腺癌(PCa)检测率的影响.方法 选取2013年2月至2015年12月在本院行前列腺穿刺的患者共320例,均行直肠超声引导下前列腺穿刺活检,分析各类患者血清PSA差异,对结果为非PCa患者于6个月后再次穿刺活检.结果 320例患者首次穿刺活检病理结果显示:其中HGPIN患者80例(孤立型51例,多灶型29例),低级别前列腺上皮内瘤(LGPIN)患者45例,前列腺增生(BPH)患者128例,PCa患者67例;其中PCa患者血清PSA为35.20(13.01,60.55) ng/mL,明显高于BPH、LGPIN、孤立型和多灶型HGPIN患者(P＜0.05);多灶型HGPIN血清PSA为12.15(6.82,16.43) ng/mL,明显高于BPH、LGPIN、孤立型HGPIN患者(P＜0.05);BPH、LGPIN、孤立型HGPIN患者血清PSA比较差异无统计学意义(P＞0.05);多灶性HGPIN患者再次穿刺为PCa的比例为38.46％ (10/26),明显高于BPH、LGPIN和孤立型HG-PIN患者(P＜0.05);BPH、LGPIN和孤立型HGPIN再次穿刺为PCa的比例比较差异无统计学意义(P＞0.05).结论 多灶型HGPIN血清PSA水平高于孤立型HGPIN、BPH以及LGPIN,但低于PCa;多灶型HGPIN患者再次活检PCa的检出率显著高于其他患者.     

良性前列腺增生术后再发前列腺癌(附3例报告及文献复习)

目的探讨良性前列腺增生术后再发前列腺癌的机理及诊治措施。方法收集泰州市第三人民医院近10 a收治的3例良性前列腺增生术后再发前列腺癌患者的临床资料,进行回顾性分析。结果 2例接受经尿道前列腺电切术治疗的患者,分别于术后第4年、8年发现前列腺癌。1例行耻骨上经膀胱前列腺切除术治疗的患者,于术后第8年发现前列腺癌。2例行开放前列腺癌根治术,1例行机器人辅助腹腔镜下前列腺癌根治术。随访至今,3例患者均健在,未发现生化复发及骨转移。结论良性前列腺增生切除术不能预防前列腺癌。直肠指检、PSA检测、直肠超声前列腺穿刺活检是诊断良性前列腺增生术后再发前列腺癌的重要方法。重视对良性前列腺增生术后再发前列腺癌的认识,早期诊断和及时采用以前列腺根治术为主的综合疗法,可获理想的预后效果。     

前列腺上皮内瘤的临床诊治

目的 探讨前列腺上皮内瘤(prostatic intraepithelial neoplasm,PIN)的临床诊断和治疗.方法 分析37例PIN患者的临床资料.良性前列腺增生合并PIN 24例,其中高级别PIN (high grade PIN,HGPIN)8例,低级别PIN (low grade PIN,LGPIN )16例,行TURP手术22例,耻骨上经膀胱前列腺摘除术2例;前列腺癌并发PIN 7例(均为HGPIN),行前列腺根治性切除术5例,2例行雄激素全阻断治疗;其余病例为单纯HGPIN 4例,LGPIN 2例.结果 24例前列腺增生合并PIN患者随访1～6年,22例健康存活,2例HGPIN因年龄＞75岁,6个月后重复前列腺穿刺为HGPIN,复查PSA＞10 ng/L行雄激素全阻断治疗,至今仍健康存活.7例前列腺癌并发HGPIN 者随访1～5年,6例均健康存活,1例5年后死亡.2例单纯HGPIN重复前列腺穿刺活检发现前列腺癌行前列腺根治性切除术,随访2～5年均健康存活.另2例单纯HGPIN及2例单纯LGPIN予临床密切观察,随访2～6年均健康存活.结论 病理检查是诊断PIN的唯一方法,HGPIN是前列腺癌的癌前病变,应给予严密随访,必要时采取积极的治疗措施.     

前列腺增生术后前列腺癌9例报告

目的:探讨BPH切除术后前列腺癌的临床特点。方法:报告9例BPH切除术后前列腺癌患者的临床资料。前列腺癌发病距BPH手术时间为0.5~8年,平均4.6年。患者BPH术后主要因尿频、排尿困难、肉眼血尿或骨痛而再次就诊。血清PSA异常8例,前列腺结节5例,同位素扫描(ECT)骨转移1例。9例均行最大限度雄激素阻断治疗,1例骨痛者行辅助放疗。结果:7例获随访0.5~8年,其中死亡2例,病变稳定4例,病变进展1例。结论:BPH切除术后的病例仍有发生前列腺癌可能,术后应定期随访,及早发现术后前列腺癌。血清PSA、直肠指检及前列腺穿刺活检是BPH术后前列腺癌诊断的主要方法;早期可行前列腺癌根治术,晚期或转移者则以内分泌治疗为主。     

125I放射性粒子近矩放射治疗前列腺癌的体会

目的探讨经会阴植入125I放射性粒子近矩放射治疗在前列腺癌治疗中的价值.方法选取90名临床上无转移病灶的前列腺癌患者,其中行125I放射性粒子近矩放射治疗患者35名,行前列腺癌根治术患者55名.术后随访前列腺特异性抗原(PSA)水平,了解相关并发症.结果接受125I放射性粒子近矩放射治疗组,治疗后3个月血清PSA较基线水平明显降低,(19.35±16.58)ng/ml vs(0.315±0.276)ng/ml,差异有统计学意义.前列腺癌根治术治疗组术后3个月血清PSA较基线水平明显降低,(13.71±5.53)ng/ml vs(0.340±0.286)ng/ml,差异有统计学意义.两组间术后3个月PSA水平差异无统计学意义.接受125I粒子近矩放射治疗组术后并发症主要为尿路刺激症和轻微血尿,前列腺癌根治术组主要为肺部感染和尿失禁.结论125I放射性粒子近矩放射治疗前列腺癌创伤小,安全性高,术后疗效满意,是一种值得推广的前列腺癌局部治疗方法.     

冷冻治疗单病灶前列腺癌12例临床分析

目的 评价冷冻疗法治疗局限性单病灶前列腺癌的近期疗效及安全性。 方法 局限性单病灶前列腺癌患者12例,均经穿刺活检证实。术前PSA 4.2～14.9 ng/ml,平均9.7 ng/ml。Gleason评分5分3例,6分5例,7分4例。临床分期T1c期8例、T2a期4例。均行超声引导下经会阴前列腺局灶冷冻治疗。术后1年内每3个月、以后每6个月复查PSA。PSA最低值≥1.0 ng/ml或PSA达最低值后上升＞2.0 ng/ml者再次行前列腺穿刺活检排除肿瘤复发。 结果 12例手术顺利,手术时间( 82±26) min,均未输血。术后住院(5±2)d。拔除尿管后,12例控尿均满意。术前有勃起功能者10例,术后仍保持勃起功能者8例。12例随访12 ～ 30个月,平均23个月。术后PSA最低值0.1～6.8 ng/ml,平均2.2 ng/ml,其中＜1.0 ng/ml者9例。术后PSA异常行前列腺穿刺活检4例,阴性3例,冷冻对侧腺体活检阳性1例。 结论 超声引导下经会阴前列腺局灶冷冻治疗安全有效、并发症少,可用于局限性单病灶前列腺癌患者,远期疗效尚需进一步观察。     

经直肠超声引导前列腺穿刺活检术（附136报告）

目的探讨经直肠超声引导前列腺穿刺活检方法及阴性患者随访策略。方法136例患者因血清tPSA〉4ng／ml或伴前列腺硬结接受穿刺活检术。根据前列腺体积或硬结情况分别选择6针、8针或10针穿刺。病理为阴性,但提示HGPIN、ASAP或PSA持续〉4ng／ml,建议3-6个月后重复穿刺活检。结果136例患者共接受1172针活检,平均8．6针。总阳性率为23．5％,其中6针、8针和10针穿刺阳性率分别为0、19．1％和34．5％（P〈0．01）。30例接受了2-3次重复活检,所有重复活检均为阴性。47例患者接受平均3．6年随访,仅1例后经TURP证实为前列腺癌,其余未发现可疑前列腺癌局部或远处转移表现。结论根据超声前列腺形态选择穿刺方案可使绝大部分前列腺癌患者初次穿刺即获得确诊。重复穿刺阳性率低,应注意选择适应症。     

经会阴前列腺癌根治术28例报告

目的 探讨经会阴前列腺癌根治术在早期局限性前列腺癌治疗中的应用价值。方法 总结28例临床分期T1a～T2b前列腺癌患者经会阴前列腺癌根治术临床资料。经直肠B超引导下前列腺穿刺活检，证实为前列腺腺癌，Gleason评分2～4分13例，5～7分15例。血清PSA2．3～16．6ng／ml，平均9．2ng／ml。术前CT或MRI检查确定前列腺癌局限于前列腺包膜内，胸部、脊椎与骨盆X线平片、ECT均未发现远处转移灶。临床分期T1a～Tb3例，T1a5例，T213例，T2b7例。结合血清PSA、临床分期和GMason评分预测临床早期前列腺癌的病理分期均在T2内，28例均行经会阴前列腺癌根治术，未行盆腔淋巴结切除。结果 术后保留导尿5d，拔除导尿管后，23例患者控尿良好，4例患者有3～7d短暂的尿失禁。发生尿道直肠瘘1例，术后2个月瘘道自行愈合。术后病理：肿瘤局限于前列腺包膜内27例，有单侧包膜外浸润（T3a）1例。28例术后随访6～30个月。术后3个月PSA〈0．04ng／ml24例，1例〈0．01ng／ml，2例未检测到PSA。1例切缘阳性（T3a）、术后PSA持续升高者，行双侧睾丸切除。术后6个月20例同时复查胸部X线片和全身骨扫描，未发现远处转移病灶。结论 经会阴前列腺癌根治术治疗早期局限性前列腺癌在肿瘤控制和排尿控制方面有突出优势，结合PSA、临床分期和Gleason评分选择的病例，不需行盆腔淋巴结切除。     

HGPIN患者血清PSA特征及首次穿刺活检HGPIN阳性针数对再次活检PCa检出率的影响

目的 考察高级别前列腺上皮内瘤(HGPIN)患者血清前列腺特异抗原(PSA)特征和首次穿刺活检HGPIN阳性针数对再次活检前列腺癌(PCa)检出率的影响.方法 使用穿刺活检法对551例疑似为PCa患者进行诊断.依据诊断结果比较各组间血清PSA水平以及首次穿刺活检HGHN阳性针数组间再次活检PCa检出率.结果 活检结果显示37.0％(204/551)患者为PCa患者,43.6％(240/551)患者为良性前列腺增生(BPH),10.7％ (59/551)患者为低级别前列腺上皮内瘤(LGPIN),48例患者为HGPIN,其中阳性针数为1针者28例、2针者13例、3针及以上者7例.PCa、阳性针数为2针以上患者PSA水平显著高于BPH患者(P＜0.05).BHP患者复诊PCa检出率12.8％(6/47)、LGPIN患者10.3％ (3/29)、单灶HGPIN患者10.7％ (3/28)、双灶HGHN患者23.1％ (3/13)、三灶及以上HGPIN患者57.1％ (4/7).结论 单灶型HGPIN血清PSA水平较低,多灶型HGPIN血清PSA水平升高,且多灶型HGPIN再次活检时PCa检出率增加.     

Evolution of isolated high-grade prostate intraepithelial neoplasia in a Mediterranean patient population.

The discovery of high-grade prostatic intraepithelial neoplasia (HGPIN) in prostatic needle biopsies is of clinical importance. Previous studies have shown prostate cancer to develop in 27-100% (average 55%) of the cases after HGPIN was diagnosed. Our preliminary findings in a Mediterranean population (Barcelona, Spain) revealed a prevalence of HGPIN of 4.4%, and an incidence of prostate cancer of 28.7% in cases in whom isolated HGPIN was identified at the first biopsy. The majority (64%) of these cases were diagnosed at the first biopsy after HGPIN diagnosis, and 52% within the first year. HGPIN persisted in 46.6% of the cases. The total mean serum prostate-specific antigen (PSA) was 9.9 +/- 6.6 ng/ml in the prostate cancer cases, compared with 8.8 +/- 7.5 in the cases without cancer. The low incidence of isolated HGPIN and subsequent cancer occurrence may be due to local factors or insufficient follow-up.     

诊断性前列腺电切术对血清PSA异常患者的应用研究

目的:探讨诊断性前列腺电切(TURP)在前列腺增生合并血清PSA异常患者中的应用价值及意义,为临床处理前列腺增生合并血清PSA异常的患者提供一种新的手段。方法:收集符合入组标准的患者71例,总结病理为前列腺癌患者的Gleason评分及预后。对所有患者进行术后随访,检测其TURP术后6个月、1年的PSA值及IPSS评分,分析术后血清PSA值、IPSS的变化,评估TURP在前列腺增生伴血清PSA异常患者中的诊疗效果。结果:①40例前列腺穿刺活检阴性而血清PSA持续异常的患者中,2例术后病理示前列腺腺癌(2/40),Gleason评分为6分,另1例电切后病理示前列腺增生组织,但术后血清PSA持续异常(18μg/L),行2次活检,病理诊断为前列腺癌,Gleason评分6分,3例均行前列腺根治性切除术,术后随访恢复好。31例拒绝活检患者中术后病理示前列腺腺癌9例(9/31)。Gleason评分7⁹分,平均8分,1例行前列腺根治性切除术,8例行内分泌治疗。②59例病理诊断为良性前列腺增生(BPH),其中血清PSA恢复正常者56例,显著降低者3例,IPSS评分有明显改善53例,6例尿道狭窄经过尿扩处理后评分亦有改善。结论:诊断性TURP可提高前列腺癌的早期检出率,改善患者的下尿路症状,且有利于患者血清PSA持续正常化。对血清PSA异常(>4μg/L),伴有下尿路梗阻状态、前列腺穿刺活检阴性的患者可考虑行诊断性TURP。     

Inverted (Hobnail) high-grade prostatic intraepithelial neoplasia (PIN): report of 15 cases of a previously undescribed pattern of high-grade PIN.

We report 15 cases of a distinctive and previously unrecognized variant of high-grade prostatic intraepithelial neoplasia (HGPIN) that is characterized by polarization of enlarged secretory cell nuclei toward the glandular lumen. We designate this lesion inverted or hobnail HGPIN. In all cases inverted HGPIN was identified on needle biopsy where it merged with typical micropapillary-tufted HGPIN. Inverted secretory cell nuclei frequently demonstrated less prominent nucleoli than adjacent noninverted secretory cell nuclei, yielding a sense of maturation that falsely suggested a non-neoplastic process. Inverted HGPIN was associated with concurrent prostatic adenocarcinoma in seven cases and with atypical glands suspicious for carcinoma in two other cases, whereas in six other cases inverted HGPIN was the only lesion identified. In both radical prostatectomies that followed these biopsies that were available for review, inverted HGPIN was localized to the peripheral zone of the prostate where it merged with usual forms of HGPIN and carcinoma. Inverted HGPIN is a morphologically distinctive form of HGPIN that shares the association with carcinoma and peripheral zone localization with other recognized forms of HGPIN.     

单纯前列腺上皮内瘤回顾性分析(附142例病例分析)

目的通过对前列腺上皮内瘤(PIN)临床资料分析,探讨PIN的生物特性及应对策略。方法对31例无前列腺癌PIN(NPCaPIN)改变患者(其中1级23例,2、3级8例)的临床资料(包括患者血清PSA、fPSA/tPSA、PSA密度等区域计数资料以及穿刺标本免疫组织化学染色结果)进行回顾性分析,以同期确诊为前列腺癌(PCa)、良性前列腺增生(BPH)患者资料作为对照,分析低级别PIN(LGPIN)和高级别PIN(HGPIN)改变之间及NPCaPIN临床特征与PCa、BPH患者临床特征的差异。结果LGPIN和HGPIN改变的患者之间血清PSA水平和年龄存在差异(P<0.05);LGPIN和PCa患者之间血清PSA水平、前列腺体积、fPSA存在显著差异(P<0.01),PSA密度、fPSA/tPSA比值存在差异(P<0.05),和BPH患者之间各项均无明显差异;HGPIN改变和PCa患者之间前列腺体积、fPSA水平和年龄存在差异(P<0.05),和BPH患者之间血清PSA水平差异显著(P<0.01),fPSA/tPSA比值和年龄(P<0.05)存在差异;NPCaPIN和PCa患者之间血清前列腺体积、fPSA水平和年龄、血清PSA水平、PSA密度存在显著差异(P<0.01),和BPH患者之间fPSA/tPSA比值(P<0.05)存在差异。P63、AE1、AE3、P504S、PSA免疫组织化学结果NPCaPIN组类似于BPH而完全异于PCa。结论LGPIN的临床和病理特征与BPH相似,而HGPIN的临床和病理方面具有一定的前列腺恶性肿瘤特征,需要积极的临床追踪观察。     

Isolated intraepithelial prostatic neoplasia and positive prostate adenocarcinoma results at repeated biopsy. Review of our series

ObjetiveTo review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literatureMaterials and methodsWe review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN ( HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them.ResultsThe diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0,52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from 3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88). The median PSA value of the studied cases was 9,8 ng /ml. The Gleason score of the positive biopsies was always between 3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies.ConclusionIn spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy ( 43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients     

Clinically unsuspected and undetected (clinical stage t0) prostate cancer diagnosed on random needle biopsy

OBJECTIVES: To describe the findings in 4 patients who underwent radical prostatectomy for clinically undetected and unsuspected prostate cancer detected on random needle biopsy. METHODS: We reviewed the Mayo Clinic Radical Prostatectomy Prostate Cancer Database of 5793 prostatectomies from 1987 to 1997, and identified 4 patients who had prostate cancer detected on random needle biopsy of the prostate with serum prostate-specific antigen (PSA) less than 4 ng/mL and normal digital rectal examination. Each had requested biopsy despite the absence of clinical suspicion of cancer; 3 had normal transrectal ultrasound, and the fourth had a benign hypoechoic lesion contralateral to the cancer. RESULTS: Mean patient age at diagnosis was 65.5 years (range 61 to 67). Mean PSA was 2.4 ng/mL (range 2 to 2.9). Mean tumor volume was 3 cc (range 0.04 to 11.2). Mean Gleason grade at prostatectomy was 5.75 (range 5 to 7). Prostate cancer was Stage T2a in 1 patient (25%), T2c in 2 (50%), and T3a (25%) in 1. Three tumors were DNA diploid, and one was aneuploid. All patients were alive without evidence of cancer at a mean follow-up of 43 months (range 25 to 53) with undetectable serum PSA concentration. CONCLUSIONS: Our findings indicate that clinically unsuspected and undetected (clinical Stage T0) prostate cancer may be clinically significant. Patient insistence on biopsy reflects increasing concern among the public about prostate cancer. Current clinical thresholds for biopsy detection will fail for some patients with clinically significant prostate cancer.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.