中晚期前列腺癌的综合治疗(附86例报告)

目的　探讨一种对中晚期前列腺癌较理想的治疗方法。方法　对经病理、X线、PSA检查及CT确诊为中晚期前列腺癌的病人进行综合治疗 (包括 1.网状支架置入 ,2 .双侧睾丸切除 ,3.放疗 ,4.抗雄激素治疗 ,5 .中药 ) 86例。与同期用单纯膀胱造瘘加双侧睾丸切除的 43例病人进行比较。结果　病人术后 3年存活率 80 .6 % ,生活质量明显改善。结论　综合治疗方法对于中晚期前列腺癌可使病人缓解症状 ,减少痛苦 ,延长寿命 ,提高生活质量。     

前列腺特异性抗原人类激肽释放酶2和前列腺特异的膜抗原在前列腺癌患者外周血表达的临床意义

目的　探讨检测前列腺癌微转移的灵敏和特异性指标。方法　从 5 1例前列腺癌、33例前列腺增生 (BPH)患者及 32名正常人的外周血中分离单个核细胞 ,用巢式RT PCR方法检测其中前列腺上皮细胞前列腺特异性抗原 (PSA)、人类激肽释放酶 2 (hK2 )和前列腺特异的膜抗原 (PSMA)的表达。结果　PSA、hK2和PSMA在前列腺癌患者外周血中检出的阳性率分别为 5 2 .9%、4 3.1%和6 4 .7% ;正常人和BPH患者假阳性率分别为 6 .2 %、7.7%和 4 .6 % ,3项指标差异均有显著性 (P <0 .0 1)。各临床分期 (局限癌、侵袭性癌和转移癌 )间 ,PSA和hK2的阳性检出率差异无显著性 ;PSMA在各期前列腺癌中阳性检出率均较PSA和hK2高 ,且随临床分期进展 ,其阳性检出率亦增加 (P <0 .0 5 )。结论PSMA对前列腺癌诊断、治疗方案的选择及预后评估较PSA和hK2有更大的价值     

睾丸切除联合最大雄激素阻断（MAB）治疗中晚期前列腺癌的疗效观察

目的：比较单纯睾丸切除与睾丸切除后联合最大雄激素阻断（ maximum androgen blockade,MAB）治疗中晚期前列腺癌的临床疗效。方法将38例中晚期前列腺癌患者划分为两组。第一组为单纯睾丸切除治疗,共17例;第二组为睾丸切除加最大雄激素阻断（ MAB）治疗,共21例,比较两组患者的血清前列腺特异性抗原（ PSA）、尿流率、前列腺大小及生存时间和质量。结果睾丸切除联合最大雄激素阻断组治疗后患者的生活质量明显优于单纯睾丸切除治疗组;而且两组在治疗12个月后,尿流率较治疗前均显著增高,血清PSA水平均显著降低,前列腺体积均明显缩小,睾丸切除联合最大雄激素阻断疗法降低血清中PSA水平效果更佳。结论睾丸切除联合最大雄激素阻断治疗中晚期前列腺癌,不仅可延长患者生存时间,还可以提高患者生存质量。     

前列腺癌患者治疗前后PSA水平

目的　探讨PSA在前列腺癌临床诊疗中的应用价值。方法　采用ELISA法测定 3 3例健康者、3 6例良性前列腺增生及 3 3例前列腺癌治疗前后T PSA和F PSA并动态观察 2 0例放疗后T PSA水平变化。结果　前列腺癌T PSA和F PSA、F/T均显著高于良性前列腺增生 (P <0 .0 1) ;前列腺癌治疗后T PSA和F PSA显著下降 (P <0 .0 1) ,而F/T无明显改变 (P >0 .0 5 ) ;前列腺癌放疗后病情稳定T PSA下降 ,病情进展则T PSA升高。结论　动态测定前列腺癌患者治疗前后PSA水平变化 ,可判断近期疗效 ,监测病情变化。     

前列腺特异性抗原的检测对前列腺癌及前列腺增生的诊断意义

目的　探讨血清总前列腺特异性抗原 (t PSA)、游离PSA (f PSA)、PSA密度 (PSAD )及其f PSA/t PSA比值对前列腺癌 (PCa)及前列腺增生 (BPH )的诊断价值。方法　采用酶联免疫分析方法 (ELISA )检测未经治疗的 62例BPH患者和 2 4例PCa患者血清f PSA、t PSA水平 ,并计算f PSA/t PSA值和PSAD ,对检测结果进行统计学处理。结果　BPH组与PCa组的f PSA、t PSA水平均明显高于对照组 (P <0 .0 1) ;前列腺癌组的f PSA /t PSA值明显小于对照组及前列腺癌增生组 (P <0 .0 1) ;PCa组PSAD明显大于对照组和BPH组 (P <0 .0 1)。结论　检测f PSA/t PSA和PSAD比单一检测f PSA、t PSA可显著提高对PCa诊断的特异性及符合率 ,对前列腺体积较大的BPH和PCa患者 ,检测PSAD更有意义     

高强度聚焦超声对中晚期前列腺癌患者去势治疗后机体免疫指标的影响

背景与目的：高强度聚焦超声(high intensity focused ultrasound,HIFU)可以有效治疗前列腺癌,但肿瘤是一种全身性的疾病,理想的肿瘤治疗方法是能够在不损伤正常组织的同时进行局部肿瘤切除,还能够激活全身的抗肿瘤免疫反应。本研究旨在探讨HIFU治疗对去势治疗后中晚期前列腺癌患者机体免疫指标的影响。方法：行去势治疗的中晚期前列腺癌患者40例,随机分为2组,HIFU组为去势治疗后2周行HIFU治疗(n=20),对照组为单纯去势治疗(n=20),全部经直肠前列腺穿刺病理检查确诊,均为晚期前列腺癌患者,即前列腺特异性抗原(prostate specific antigen,PSA)>20 ng/mL。患者自愿接受HIFU治疗并签署知情同意书。HIFU组与对照组患者平均年龄(72.56±12.38)岁、(75.23±9.35)岁(P=0.446 3);初始PSA为(105.22±20.55)ng/mL、(100.53±18.38)ng/mL(P=0.451 5)。分别取治疗前和治疗后2周前列腺癌患者外周血6 d,检测T淋巴细胞亚群(CD4⁺、CD8⁺、CD4⁺/CD8⁺)和外周血Th细胞因子(IFN-γ、IL-2、IL-4、IL-10)。结果：HIFU组患者治疗后CD4⁺百分比及CD4⁺/CD8⁺比值明显升高;细胞因子IFN-γ、IL-2水平明显增高,而IL-4、IL-10水平明显降低,与治疗前相比差异有统计学意义(P＜0.05),Th1/Th2平衡向Th1漂移。而对照组患者治疗前、后各项免疫指标差异无统计学意义(P＞0.05)。HIFU组与对照组前、后各项免疫指标差值比较差异有统计学意义(P＜0.05)。结论：HIFU治疗可在近期内改善去势治疗后中晚期前列腺癌患者机体免疫功能。     

血清睾酮和前列腺特异抗原水平对早期前列腺癌的诊断价值

目的探讨血清睾酮和前列腺特异抗原(PSA)联合检测对早期前列腺癌的诊断价值。方法选取2018年1月至2019年2月间四川省广元市第一人民医院收治的97例早期前列腺癌患者作为研究1组,抽取同期就诊的81例前列腺增生患者作为研究2组,同期进行健康体检的79例正常受试者作为对照组,观察三组睾酮和PSA水平及二者对早期前列腺癌的诊断价值。结果三组组间睾酮和PSA水平比较,差异有统计学意义(P <0. 05),进一步两两比较显示,研究2组和对照组的睾酮水平高于研究1组,PSA水平高于研究1组,差异均有统计学意义(均P <0. 05)。研究2组和对照组的睾酮水平比较,差异无统计学意义(P> 0. 05),研究2组PSA水平高于对照组,差异有统计学意义(P <0. 05)。睾酮诊断前列腺癌105例,漏诊24例,误诊32例; PSA诊断前列腺癌80例,漏诊35例,误诊18例;睾酮或PSA之一阳性诊断前列腺癌133例,漏诊5例,误诊41例;睾酮和PSA二者均阳性诊断前列腺癌62例,漏诊42例,误诊7例。睾酮或PSA之一阳性诊断前列腺癌的灵敏度高于睾酮、PSA及睾酮和PSA均阳性,差异均有统计学意义(均P <0. 05);睾酮和PSA均阳性诊断前列腺癌的特异性高于睾酮、PSA和睾酮或PSA之一阳性,差异均有统计学意义(均P <0. 05)。结论 PSA和睾酮联合诊断方式有助于诊断前列腺癌,值得临床推广应用。     

血清前列腺特异抗原检测对前列腺癌早期诊断价值探讨

目的　探讨血清前列腺特异抗原 (PSA)对前列腺癌的早期诊断价值。方法　采用双抗体夹心酶联免疫法 (ELISA)检测健康对照组 110例 ;前列腺增生症 42例 ;前列腺炎 15例 ;前列腺癌 2 5例血清PSA水平。结果　前列腺癌组的血清PSA平均水平 (40 72 5±19 6 0 2ng/ml) ,明显高于健康对照组 (2 745± 1 12 4ng/ml) (P <0 0 1) ;而前列腺增生症组 (3 35 2± 1 30 2ng/ml)和前列腺炎组 (3 72 5± 1 412ng/ml)与健康对照组比较没有显著性差异 (P >0 0 5 )。结论　检测血清PSA水平对前列腺癌的早期诊断有重要参考价值。     

经尿道前列腺切除术在前列腺癌早期诊断中的意义

目的 评价经尿道前列腺切除术(TURP)在前列腺癌早期诊断中的作用.方法 采用TURP方法对16例血清前列腺特异抗原(PSA)轻度升高(平均11.7 ng/ml),直肠指诊和前列腺穿刺活检阴性,但PSA持续升高或者合并有明显下尿路症状,或者PSA升高却不宜活检的可疑前列腺癌病例行TURP.6例通过病理学诊断确诊前列腺癌.其中3例又行双侧睾丸切除术加间断抗雄激素药物治疗,2例行药物去势加抗雄激素药物治疗,1例在新辅助内分泌治疗后行根治性前列腺切除术.结果 对6例经TURP诊断为前列腺癌的患者随访3个月～2年,全部生存.TURP使2例前列腺癌合并下尿路症状患者的症状得到缓解.结论 TURP对部分前列腺癌有早期诊断作用,同时可以缓解合并的下尿路症状.     

经尿道等离子前列腺电切术联合睾丸切除术治疗中晚期前列腺癌的临床疗效及对前列腺特异抗原水平的影响

目的探究经尿道等离子前列腺电切术联合睾丸切除术治疗中晚期前列腺癌的临床疗效及对前列腺特异抗原水平的影响。方法回顾性分析2012年6月至2015年6月间收治的120例中晚期前列癌患者的临床资料,采取随机数字表法将患者分为试验组和对照组,每组60例。试验组患者均采用经尿道等离子前列腺电切术联合睾丸切除术治疗,对照组患者均采用常规手术行前列腺和睾丸联合切除术,对比两组患者治疗前后国际前列腺症状评分(IPSS)、前列腺特异抗原(PSA)、最大尿流率(MFR)、残余尿量、前列腺体积及生活质量。结果治疗后,试验组患者较对照组患者的IPSS评分降低,血清PSA水平降低,MFR升高,剩余尿量减少,前列腺体积缩小,差异均有统计学意义(P<0.05)。与对照组患者治疗后比较,试验组患者的躯体功能、角色功能、情绪功能、认知功能、社会功能及总体健康状况评分均明显提高,差异均有统计学意义(P<0.05)。与对照组比较,试验组患者手术治疗后排尿困难症状明显缓解,恢复自主排尿率高(96.7%和80.0%),发生尿失禁率低(0.0%和8.3%),差异均有统计学意义(P<0.05)。试验组患者随访6~24个月,56例患者仍带瘤生存。对照组患者随访5~25个月,46例患者目前仍带瘤生存。结论采用经尿道等离子前列腺电切术联合睾丸切除术治疗中晚期前列腺癌的临床疗效显著,血清PSA水平降低,显著改善了患者的生活质量,值得推广与应用。     

血清hK2、AMACR联合PSA检测对前列腺癌诊断及预后判断的临床价值

目的:探讨血清腺激肽释放酶2（hK2）、甲基酰基辅酶A消旋酶（AMACR）联合前列腺特异性抗原（PSA）检测对前列腺癌诊断及预后判断的临床价值。方法:前瞻性选取2016年01月至2018年01月收治的前列腺癌患者50例为前列腺癌组和良性前列腺增生患者50例为良性前列腺增生组。并以同期健康查体者50例为对照组。检测比较三组血清hK2、AMACR和PSA水平,Logistic分析血清hK2、AMACR和PSA水平对前列腺癌发生状况的影响,ROC曲线分析血清hK2、AMACR和PSA水平联合检测对前列腺癌的诊断效能。对前列腺癌组进行为期3年的随访,记录患者复发和生存情况。比较不同复发和生存预后情况患者的基线血清hK2、AMACR和PSA水平,Logistic分析基线血清hK2、AMACR和PSA水平对前列腺癌患者复发和生存预后的影响,ROC曲线分析血清hK2、AMACR和PSA水平联合检测对前列腺癌患者复发和死亡早期评估效能。结果:前列腺癌组血清hK2、AMACR水平高于良性前列腺增生组和对照组（P＜0.05）;而良性前列腺增生组和对照组血清hK2、AMACR水平比较差异无统计学意义（P＞0.05）。前列腺癌组、良性前列腺增生组和对照组的血清PSA水平依次降低（P＜0.05）。Logistic分析结果显示,血清hK2、AMACR和PSA水平对前列腺癌发生状况具有明显影响（P＜0.05）。ROC曲线分析结果显示血清hK2、AMACR和PSA水平联合检测对前列腺癌具有良好的诊断效能。前列腺癌组50例患者的3年复发率和生存率分别为56%（28/50）和52%（26/50）。前列腺癌组复发患者的血清hK2、AMACR和PSA水平均高于未复发患者（P＜0.05）;且前列腺癌组死亡患者的血清hK2、AMACR和PSA水平均高于存活患者（P＜0.05）。Logistic分析结果显示,血清hK2、AMACR和PSA水平均受到前列腺癌患者复发和生存预后的影响（P＜0.05）。ROC曲线分析结果显示血清hK2、AMACR和PSA水平联合检测对前列腺癌患者复发和死亡均具有良好的早期评估效能。结论:血清hK2、AMACR和PSA水平在前列腺癌患者中表达水平较高,具有一定的前列腺癌诊断价值,且可能作为预后早期预测的有效参考指标。     

Screening for prostate cancer using prostate-specific antigen alone as a first-line checkup parameter: results of the health checkup system

Background: The incidence of prostate cancer in Japan is notvery high but it is the most increasing malignant tumor form.To decrease the mortality from cancer, detection of early cancerand early treatment are most effective. As a primary screeningfor prostate cancer, measurement of serum prostate-specificantigen(PSA) added to the health checkup system has not beenassessed. Methods: Among males who received a health checkup during a30-month period, serum PSA levels were measured in males whodesired prostate cancer screening. The cut-off value for PSAwas 4.0 ng/ml. Males with serum PSA levels exceeding this valuewere referred for further screening by digital rectal examination(DRE) and transrectal ultrasonography (TRUS). In secondary screening,in all males with PSA levels of 10.0 ng/ml or more and in malesin whom PSA levels were within the gray zone (4.0-10.0 ng/ml)and either DRE or TRUS showed abnormal findings, systematicprostate sextant needle biopsy was performed. Results: Of 24 528 males who received a health checkup, 1125(4.6%) underwent prostate cancer screening. In 60 (5.3%) ofthese males, PSA levels exceeded the cut-off value. In 34 of50 males who received further screening, prostate biopsy wasperformed. Seventeen males were diagnosed as having prostatecancer. Detection rates of prostate cancer were 1.53% (17/1125)in males overall and 2.1% (17/819) in males     

Testicular Metastasis of Prostate Cancer: A Case Report

The incidence of secondary neoplasms of the testis during autopsies is approximately 2.5%. Although most secondary testicular metastases are due to prostate cancer, only a few patients with prostate cancer have clinically manifested testicular metastasis. We report the case of a prostate cancer patient with testicular metastasis who was diagnosed after the presence of a palpable mass in the right testis. A 56-year-old Japanese male presented to our hospital with an elevated serum prostate-specific antigen (PSA) level of 137 ng/ml. He was diagnosed with stage IV (T3N1M1b) prostate cancer and received androgen deprivation therapy, followed by various hormonal manipulations. His serum PSA level was undetectable for 1 year. No distant metastases were detected during imaging examinations. He received radiation therapy; however, his serum PSA level increased gradually. Four months later, he presented with right testicular swelling. Computed tomography revealed a heterogenous mass in the right testis and a right high inguinal orchiectomy was performed. Histopathological analysis showed that the right testis was infiltrated with metastatic adenocarcinoma with a Gleason score of 8. This is a rare case of right testicular metastasis in a patient with prostate cancer. Testicular metastasis of prostate cancer can be aggressive and metastasize.Key Words: Prostate cancer, Testicular metastasis, Orchiectomy     

前列腺癌的早期诊断

目的：评价前列腺癌早期诊断的方法及提高对一些基本诊断方法的认识。方法：对１９９１－１９９９年诊治的７０例早期前列腺癌所应用的基本诊断技术进行分析。结果：７０例患者中,６４例（９１．４％）ＤＲＥ（直肠指诊）发现前列腺异常。６６例患者接受ＰＳＡ（前列腺特异抗原）检查,其中ＰＳＡ〉４ｎｇ／ｍｌ者５２例（７８．８％）。６６例患者接受ＴＲＵＳ（经直肠前列腺Ｂ超）检查,其中５４例（８１．８％）发现异常。若将２     

比卡鲁胺联合戈舍瑞林间断性治疗前列腺癌临床研究

目的:观察比卡鲁胺联合戈舍瑞林间断性治疗对前列腺癌患者血清PSA、f-PSA的影响,及对排尿梗阻症状、骨转移灶和骨痛感的疗效。方法:将本院2005年7月-2012年7月收治的前列腺癌患者84例分为手术去势组20例,持续药物去势组32例和间歇药物去势组32例。手术去势组病例行双侧睾丸切除术,并口服比卡鲁胺治疗,持续药物去势组予比卡鲁胺合戈舍瑞林治疗,间歇药物去势组给药同持续药物去势组,当患者血清PSA值降至0.2ng/ml以下时停止给药,PSA值重新升至4ng/ml以上时,再给药治疗。分别在治疗前、治疗后1、3、6、12个月时观察三组患者的血清PSA、f-PSA变化,及有排尿梗阻症状、骨转移灶和骨痛感患者的变化。结果:三组患者治疗后血清PSA、f-PSA值较本组治疗前均有明显下降（P＜0.01）。三组治疗后血清PSA、f-PSA值同时间组间比较无显著差异（P＞0.05）。三组治疗后有自觉排尿梗阻症状、有骨转移灶及有骨痛感的患者数较本组治疗前均有明显减少（P＜0.05）。结论:比卡鲁胺联合戈舍瑞林间断性疗法对前列腺癌的控制治疗可与持续疗法和手术去势疗法收到同样疗效。     

The value of digital rectal examination as a predictor of prostate cancer diagnosis among United States Veterans referred for prostate biopsy

BACKGROUND: As digital rectal examination (DRE) remains an essential part of a routine physical examination, it is important to understand its diagnostic value in different circumstances. AIM: To quantify sensitivity, specificity and predictive value of DRE as a predictor of biopsy-confirmed prostate cancer in the US Veteran population. METHODS: The study group included 628 consecutive patients who underwent transrectal biopsy for suspected prostate cancer due to abnormal digital examination of the prostate, elevated serum prostate specific antigen (PSA) or both. The DRE results reported in this study are documented during physical examinations that were performed after referral for biopsy. The relation between DRE results and positive biopsy was examined while taking into consideration demographic and clinical patient characteristics. RESULTS: Among men with normal PSA the adjusted odds ratio (OR) reflecting the association between abnormal DRE and positive prostate biopsy was 0.53 with a 95% confidence interval (CI) from 0.27 to 1.06. In the presence of a moderately elevated (4.1-10 ng/mL) PSA, the OR was 1.07 (0.72-1.60). When serum PSA exceeded 10 ng/mL, the OR was 2.15 (1.12-4.43). The positive predictive value of an abnormal DRE varied widely from as high as 81% to as low as 14% depending on the other patient characteristics. DISCUSSION: These results indicate that DRE results are most informative when evaluated in conjunction with other clinical and demographic information.     

Expression of soluble urokinase plasminogen activator receptor may be related to outcome in prostate cancer patients

The urokinase-type plasminogen activator receptor (uPAR) exists as a GPI anchored glycoprotein (Mr=50-60 kDa) on the surface of various cell types. This receptor can be bound by or cleaved by urokinase. The cleaved receptor, soluble urokinase-type plasminogen activator receptor (suPAR), with an Mr=35 kDa has no known physiological function and can be identified circulating in the blood of normal individuals. Although no function has been characterized, the soluble receptor has been reported to be of clinical significance. The objective of this study is to characterize novel serum markers that can be used for the early detection of prostate cancer and to predict patient prognosis. Thirty-nine patients at the University of Yaounde I, Yaounde, Cameroon, West Africa were examined for prostatic disorders. Of these, 46% were diagnosed with benign prostate hyperplasia (BPH), while 44% of the patients were diagnosed via biopsy with prostate cancer and graded accordingly. Here we show that serum from patients with BPH or prostate cancer contains elevated levels of suPAR. To examine the significance of suPAR as a diagnostic factor, we used a suPAR ELISA kit and compared these results with serum levels of prostate specific antigen (PSA), the current diagnostic marker for prostate cancer. PSA and serum suPAR levels in BPH and cancer patients were greatly elevated in the majority of patients, while others had undetectable levels of either. Serum levels of suPAR were high in cancer patients as well as, although to a lesser degree, in patients with BPH. Cancer patients who died during the follow-up period were found to have consistently higher serum suPAR levels than correlating serum PSA levels. These preliminary findings are the first evaluating serum suPAR levels as a possible diagnostic marker for the early detection of prostate cancer and for the prediction of patient prognosis.     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

Prostate-Specific Antigen: Questions Often Asked

In conclusion, an effective new marker for prostatic tissue has been identified and is commonly known as PSA. A review of the literature indicates that although PSA is not tumor specific, its organ-site and cell-type specificity provide the basis for making PSA the marker of choice for use in patients with prostate cancer. The clinical utility of PSA includes monitoring therapeutic efficacy, screening and early diagnosis in high-risk patients, prognosis, staging, and tumor volume evaluation, prediction of disease progression, detection of recurrent disease after radical prostatectomy, and the differential diagnosis and confirmation of tissue for prostatic origin. PSA is not a "magic bullet" for patients with prostate cancer. Many questions must still be answered. For example, with an increase in sensitivity for screening of high-risk populations, how does the urologist/oncologist determine which patients with latent curable early cancer will develop into clinically significant metastasis? Is PSA a more reliable method for detection of early prostate cancer than rectal examination? What procedure should be followed for an asymptomatic patient who presents a 35 ng/ml level of PSA during a routine physical examination? Clearly, further studies are required to answer these questions as well as to assess the malignant potential of the prostatic tumor cell. For now, the combination of PSA, rectal examination, and transrectal ultrasonography guided needle biopsy would appear to be the method of choice to decrease the yearly fatalities due to cancer of the prostate.