膀胱原发性印戒细胞癌伴发前列腺腺癌1例报告及文献复习

目的:探讨膀胱原发性印戒细胞癌(primary signet ring cell carcinoma of the bladder.PSRCC)伴前列腺癌的临床特征及诊治方法。方法:总结1例膀胱PSRCC伴前列腺癌患者的资料,检索Pubmed、CBM数据库相关文献并复习。结果:膀胱镜检病理示膀胱印戒细胞癌。血PS A:12.73 ng/ml,FPSA:0.737 ng/ml,FPSA/PSA:0.06。前列腺穿刺活检示前列腺腺癌,Gleason评分3+3。行经尿道膀胱肿瘤切除术(TURBT)术和最大限度雄激素阻断治疗,术后1 6个月膀胱癌复发。结论:膀胱PSRCC临床少见,浸润性强,进展快,诊断主要依靠病理和免疫组织化学检查,对于膀胱PSRCC伴发前列腺癌首选根治性膀胱前列腺切除术治疗,预后差。     

低血清PSA型前列腺癌的回顾性研究

目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。     

全雄激素阻断和全雄激素阻断结合125Ⅰ放射微粒植入治疗前列腺癌

目的:探讨全雄激素阻断和全雄激素阻断结合125Ⅰ放射微粒植入治疗前列腺癌的临床疗效.方法:收集我院近10年来中晚期前列腺癌病人44例,其中C期28例,D期16例.双侧睾丸切除+抗雄激素药物治疗(A组)35例,双侧睾丸切除+抗雄激素药物+125Ⅰ放射微粒植入近距离放射治疗(B组)9例.比较治疗前后PSA的变化及生存率.结果:A组35例病人PSA平均值由60.3μg/L降至12.1μg/L.B组9例病人PSA平均值由72.1μg/L降至3.6μg/L.35例A组病人随访9～84(平均39.2)个月,排除非癌性死亡3例,因前列腺癌引起的死亡6例,生存率为81.3%(26/32).B组9例病人随访7～24(平均13)个月,病人全部存活.结论:全雄激素阻断治疗及全雄激素阻断治疗结合125Ⅰ放射微粒植入近距离放射治疗,是治疗中晚期前列腺癌的可供选择的有效方法.     

全雄激素阻断和全雄激素阻断结合~(125)I放射微粒植入治疗前列腺癌

目的 :探讨全雄激素阻断和全雄激素阻断结合12 5I放射微粒植入治疗前列腺癌的临床疗效。　方法 :收集我院近 10年来中晚期前列腺癌病人 44例 ,其中C期 2 8例 ,D期 16例。双侧睾丸切除 +抗雄激素药物治疗 (A组 )35例 ,双侧睾丸切除 +抗雄激素药物 +12 5I放射微粒植入近距离放射治疗 (B组 ) 9例。比较治疗前后PSA的变化及生存率。　结果 :A组 35例病人PSA平均值由 6 0 .3μg/L降至12 .1μg/L。B组 9例病人PSA平均值由72 .1μg/L降至 3.6 μg/L。 35例A组病人随访 9～ 84(平均39.2 )个月 ,排除非癌性死亡 3例 ,因前列腺癌引起的死亡 6例 ,生存率为 81.3%(2 6 / 32 )。B组 9例病人随访 7～ 2 4(平均 13)个月 ,病人全部存活。　结论 :全雄激素阻断治疗及全雄激素阻断治疗结合12 5I放射微粒植入近距离放射治疗 ,是治疗中晚期前列腺癌的可供选择的有效方法。     

原发性前列腺印戒细胞癌1例报告并文献复习

目的:探讨原发性前列腺印戒细胞癌的临床特点。方法:回顾性分析1例原发性前列腺印戒细胞癌患者的临床资料:患者64岁,因进行性排尿困难2年,肉眼血尿2个月入院治疗,行经尿道前列腺电切术。结果:术后病理检查为前列腺印戒细胞癌伴黏液腺癌及管状乳头状腺癌。免疫组织化学结果:PSA+,PAP+,CEA-。术后给予局部放射治疗,随访8个月未见复发和转移。结论:原发性前列腺印戒细胞癌临床罕见,恶性程度高,易出现转移,需依赖组织病理学及免疫组织化学检查确诊。     

前列腺小细胞癌2例报告及文献复习

目的:探讨前列腺小细胞癌的临床病理特征,提高其临床诊治水平。方法:通过2例前列腺癌治疗后转化为前列腺小细胞癌的病例报告并复习相关文献。结果:2例患者因PSA升高行前列腺穿刺,病理诊断均为前列腺癌,均行最大限度雄激素阻断治疗,治疗后PSA降至正常水平;后因排尿困难行前列腺电切术,术后病理诊断为前列腺小细胞癌,行化疗或放疗,于发现小细胞癌后8～9个月死亡。结论:前列腺小细胞癌可由前列腺腺癌治疗后转化而来,病理转化最可能的机制是长期内分泌治疗所诱发突变。前列腺小细胞癌较前列腺腺癌恶性程度高,预后差。     

全雄激素阻断和全雄激素阻断结合^125I放射微粒植入治疗前列腺癌

目的：探讨全雄激素阻断和全雄激素阻断结合^125I放射微粒植入治疗前列腺癌的临床疗效。方法：收集我院近10年来中晚期前列腺癌病人44例，其中C期28例，D期16例。双侧睾丸切除 抗雄激素药物治疗(A组)35例，双侧睾丸切除 抗雄激素药物 ^125I放射微粒植入近距离放射治疗(B组)9例。比较治疗前后PSA的变化及生存率。结果：A组35例病人PSA平均值由60．3μg／L降至12．1μg／L。B组9例病人PSA平均值由72．1μg／L降至3．6μg／L。35例A组病人随访9～84(平均39．2)个月，排除非癌性死亡3例，因前列腺癌引起的死亡6例，生存率为81．3％(26／32)。B组9例病人随访7～24(平均13)个月，病人全部存活。结论：全雄激素阻断治疗及伞雄激素阻断治疗结合^125I放射微粒植入近距离放射治疗．是治疗中晚期前列腺癌的可供选择的有效方法。     

原发性前列腺印戒细胞癌(附二例报告及文献复习)

目的：探讨原发性前列腺印戒细胞癌的临床特点。方法：分析2例原发性前列腺印戒细胞癌患者的临床资料，结合文献得以讨论。结果：2例患者年龄分别为64岁和73岁，临床表现为排尿困难、膀胱刺激症及会阴不适。组织学：印戒状癌细胞呈圆形，胞质丰富透明，胞核呈新月状位于细胞一侧，核分裂像多见。免疫组化染色PCA（ ）、PAP( )、AR( )、低分子CK( )，CEA（-）、AB/PAS（-）。1例D期患者行双侧睾丸切除及氟他胺治疗，术后6个月死于广泛转移；1例B2期患者行根治性前列腺切除、双侧睾丸切除、内分泌和局部放射治疗，随访25个月未见复发和转移。结论：原发性前列腺印戒细胞癌是一种罕见、高度恶性的肿瘤，确诊需依赖组织病理学及免疫组织化学检查。     

原发性前列腺印戒细胞癌(1例报告并文献复习)

目的探讨原发性前列腺印戒细胞癌的临床特征。方法回顾性分析1例原发性前列腺印戒细胞癌患者的临床资料,并结合文献进行复习讨论。结果患者前列腺穿刺活检病理报告为前列腺印戒细胞癌,免疫组织化学检查示PSA( ),PAS、CEA、LCA、CKH(-),行双侧睾丸切除术和氟他胺治疗,术后1月死于肺部转移。结论原发性前列腺印戒细胞癌来自前列腺腺泡上皮,确诊依靠病理组织学和免疫组化检查。临床罕见,恶性程度高,预后较差。     

良性前列腺增生术后前列腺癌

目的 :提高对前列腺增生术后前列腺癌的认识。　方法 :回顾总结 1 2例 (年龄 6 3～ 82岁 )前列腺增生术后前列腺癌患者的临床资料。前列腺增生术后 1 0个月～ 1 4年 ,平均 5 .6年 ,发现前列腺癌。患者因排尿困难、血尿、疼痛而再次就诊。发现前列腺特异抗原 (PSA)异常 1 1例 ,前列腺结节 8例。B期 3例、C期 3例、D期 6例。 1 2例均行睾丸切除术 ,其中 1 0例加用雄激素受体阻断剂 ,3例行经尿道前列腺切除术 (TURP)。　结果 :随访 4个月～ 8年 ,平均 4 .5年。死亡 3例 ,病变稳定 6例 ,2例病变进展。　结论 :前列腺增生手术不能预防前列腺癌的发生 ,血清PSA和直肠指检是前列腺增生术后前列腺癌诊断的主要方法     

Raised prostate-specific antigen in adenocarcinoma of the colon

Serum prostate-specific antigen (PSA) values above 10 ng/ml are considered highly sensitive and specific for prostatic carcinoma in the absence of prostatic inflammation or trauma. However, in rare instances, non-prostatic malignancies have also been associated with raised serum PSA values. We have encountered a patient with increased serum PSA concentration measured by monoclonal antibody assay who had no evidence of prostatic malignant involvement, but suffered from colon cancer. Before operation for colon cancer his PSA was always over 30 ng/ml on several examinations. After total removal of colon cancer serum PSA level fell down to 1.2 ng/ml. Although immunohistochemical staining of colon cancer with monoclonal PSA antibody was not performed, some relationship between raised PSA and colon cancer is strongly suspected. Substances like serine protease which can cross-react with the PSA antibody might be produced by malignant tumour of non-prostatic origin.     

良性前列腺增生TURP术后病理诊断前列腺癌27例分析

目的探讨前列腺增生症病人经尿道前列腺电切（TURP）术后病理检出前列腺癌的临床特点及治疗措施。方法对三家医院于2003年1月～2006年12月经尿道前列腺电切术（TURP）327例进行回顾性分析,对比术后病理诊断为前列腺癌的患者与前列腺增生的患者的前列腺抗原及前列腺特异性抗原密度（PSAD）。结果327例患者中PSA在4～10ng/ml间者共112例,PSA在10～20ng/ml之间者共15例。术后病理诊断为前列腺癌的27例,其中有21例患者的PSAD值高于0.15。结论经尿道前列腺电切术（TURP）是早期发现前列腺癌的重要手段;前列腺特异性抗原密度（PSAD）有助于更好地鉴别前列腺增生症和前列腺癌。     

Value of PSA in the staging of prostatic cancer]

The clinical value of Serum Prostate Specific Antigen (PSA) in the staging of prostatic carcinoma was evaluated in 62 patients who underwent radical retropubic prostatectomy. Preoperative levels of PSA were compared with the final pathological stage obtained from all surgical specimens examined for capsular penetration, seminal vesical invasion and lymph node involvement. PSA level was closely correlated with the volume and the stage of the prostatic carcinoma. 93% of the patients with PSA < or = 10 ng/ml had tumor confined to the gland. All patients with PSA > 20 ng/ml had extraprostatic tumor extension (stage C or D). Patients with histologically proved prostatic carcinoma, PSA > 20 ng/ml and negative bone scan can be assumed to have extraprostatic disease and/or lymphatic involvement. Patients with PSA (drawn in the requested conditions) < or = 10 ng/ml can be considered to have organ confined disease, and can be spared a bone scintigraphy. Our study indicate an increasing role of PSA in the clinical staging of patients with prostatic carcinoma.     

f/t PSA比值、PSA密度、PSA移行带密度在tPSA灰区前列腺偶发癌诊断中的意义

【摘要】 目的： 探讨血清f/t PSA比值、PSA密度、PSA移行带密度在tPSA位于灰区时前列腺癌诊断中的意义。方法： tPSA位于4～10ng/ml的前列腺增生患者112例,术前经前列腺穿刺活检均证实为前列腺增生,行TURP术后病理证实21例为前列腺偶发癌患者。回顾性分析该21例前列腺偶发癌患者和其余前列腺增生患者间的血清f/t PSA比值、PSA密度、PSA移行带密度,并进行统计学分析,以了解其在tPSA灰区前列腺偶发癌诊断中的意义。结果：前列腺偶发癌组和BPH组血清f/t PSA比值分别为0.13±0.03、0.21±0.04;PSAD分别为0.20±0.05 ng/ml2 、0.12±0.04 ng/ml2;PSATZ分别为0.38±0.06 ng/ml2 、 0.21±0.05 ng/ml2;两组在以上三个检测指标上差异具有显著性(P<0.05)。以0.15 ng/ml2为截断点则PSAD 灵敏性为76.115%,特异性为69.146%;以0.35 ng/ml2为截断点则PSATZ 灵敏性为60.642%,特异性为93.943%。结论：f/t PSA比值、PSAD、PSATZ对前列腺偶发癌的诊断具有重要价值,其中尤以PSATZ更具预测价值。     

Should high-grade prostatic intraepithelial neoplasia change our approach to infravesical obstruction?

OBJECTIVES: To investigate whether coexistence of high-grade prostatic intraepithelial neoplasia (HPIN) should change our therapeutic approach to infravesical obstruction. MATERIAL AND METHODS: Of 505 patients who underwent sextant transrectal ultrasonography (TRUS)-guided prostate biopsy, 65 (12.8%) had HPIN and 29 of them underwent prostatectomy (23 transurethral resection of prostate (TURP), 6 open) due to obstructive urinary symptoms. Patients without carcinoma were followed up with semiannual prostate-specific antigen (PSA) and digital rectal examination. After a follow-up of 24.8 +/- 11.0 months, 19 of 29 patients who accepted our call had another sextant biopsy. RESULTS: Mean age and initial mean PSA values of 29 patients were 67.6 +/- 6.7 years and 9.26 +/- 5.91 ng/ml, respectively. The final pathological evaluation of the surgical specimens revealed 2 prostatic adenocarcinomas both in the TURP group. The remaining 27 (93.2%) patients were found to have benign prostatic hyperplasia (BPH) and their serum PSA levels declined from 9.26 +/- 5.91 to 4.59 +/- 2.0 ng/ml 3 months after prostatectomy. Of the 19 patients who had another biopsy with a mean PSA value of 4.06 +/- 4.61 ng/ml, 15 and 4 of them had BPH and HPIN respectively. CONCLUSIONS: Our preliminary data indicate that the presence of HPIN on TRUS-guided biopsies is not a factor to delay an indicated surgical intervention for infravesical obstruction.     

Pure prostatic papillary adenocarcinoma with ductal features

Papillary adenocarcinoma resembling ductal carcinoma and arising in the peripheral zone is extremely rare. We report a case of prostatic papillary adenocarcinoma with ductal features. The patient was a 68-year-old man who initially presented with dysuria and sensation of residual urine after voiding. Prostatic needle biopsy findings supported pathological diagnosis of prostatitis. The symptoms were improved by medication for prostatitis, and prostate-specific antigen (PSA) level of 22.6 ng/ml descreased to 9.9 ng/ml. It remained between 7.2 ng/ml and 9.9 ng/ml for 2 years. However, it gradually increased to 11.9 ng/ml. Transrectal digital examination, T2-weighted magnetic resonance imaging (MRI) of the prostate and transrecral ultrasound showed a mass in the enlarged right side of the prostate. Transrectal needle biopsy of the mass was performed, and papillary adenocarcinoma was suspected by histological examination. Radical prostatectomy was performed. Histological and immunohistochemical examination of the prostatectomy specimen revealed pure prostatic papillary adenocarcinoma with ductal features.     

PSA、PSAD和PSAT对前列腺癌诊断的比较

目的　比较前列腺移行带特异性抗原密度（PSAT）与前列腺特异性抗原（PSA）及前列腺特异性抗原密度（PSAD）在前列腺癌诊断中的意义。方法　对78例PSA4～20ng/ml的患者行前列腺穿刺活检后比较PSA、PSAD和PSAT指标。结果　78例中,病理诊断为前列腺癌(PCa)32例,良性前列腺增生(BPH)46例,二者PSA平均值分别为(14.32±1.46)ng/ml、(13.89±1.52)ng/ml,二者相比差别无显著性意义(P>0.05);PSAD平均值分别为0.43±0.14、0.36±0.17,二者相比差别有显著性意义(P<0.05);PSAT平均值分别为0.75±0.19、0.31±0.06,二者相比差别有非常显著性意义(P<0.01)。结论　PSAD和PSAT对预测PSA<20ng/ml的患者是否患前列腺癌有较大帮助,特别是PSAT更为准确。     

转移性前列腺癌的预后及相关因素分析

目的 探讨转移性前列腺癌的预后及相关因素. 方法 转移性前列腺癌患者32例.平均年龄71(54～87)岁.均经直肠标准6点前列腺穿刺活检证实为前列腺癌,阳性点数1～2点4例、3～4点7例、5～6点21例.Gleason评分2～6分2例、7分19例、8～10分11例.临床分期T_(1-2c)N_1M_0 6例、T_(2c)N_1M_1 1例、T_(3a)N_1 M_1 13例、T_(3a)N_2 M_1 2例、T(3b)N_1 M_1 5例、T_(3b)N_2 M_1 1例、T_4N_1 M_1 4例.治疗前血清PSA值63～2000 ng/ml,中位数158 ng/ml;血清睾酮平均11.4(4.4～50.7)nmol/L.骨转移27例,其中合并盆腔淋巴结转移8例,单纯淋巴结转移5例.采用手术去势加雄激素阻断(比卡鲁胺50 mg/d或氟他胺250 mg 3次/d)治疗.一线内分泌治疗时间7～48个月,中位时间23个月.一线内分泌治疗失败后,改用己烯雌酚或雌二醇氮芥治疗,41%的患者对二线内分泌治疗不敏感,59%的患者对二线治疗有效,持续时间3～15个月.统计学分析患者预后与治疗前各指标的相关性. 结果 32例患者平均随访33(13～98)个月.28例确诊后13～86个月死亡.存活4例,随访78-98个月.中位生存时间37个月.1、3、5年存活率分别为100%(32/32)、53%(17/32)、19%(6/32).患者生存期与治疗前血清PSA(r=-0.262,P=0.045)、Gleason评分(r=0.624,P=0.001)呈负相关,与治疗前睾酮水平(r=0.514,P=0.008)及年龄(r=0.311,P=0.032)呈正相关,与治疗前穿刺活检阳性点数(r=0.211,P=0.158)及临床分期(r=0.058,P=0.352)无关. 结论 转移性前列腺癌预后与患者术前睾酮水平、年龄、Gleason评分、血清PSA有关,与治疗前穿刺活检阳性点数及临床分期无关.     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

A prostatic duct carcinoma difficult to distinguish from transitional cell carcinoma: a case report

A 77-year-old male with a complaint of dysuria and gross hematuria for 3 months visited our hospital. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging revealed a prominent tumor from the bladder neck. Serum prostate specific antigen (PSA) level was high (1,130 ng/ml) suggesting prostate cancer, but transitional cell carcinoma (TCC) was detected by transurethral biopsy. Bone scintigraphy revealed multiple bone metastasis. Since gross hematuria requiring bladder tamponade continued, simple cystoprostatectomy and cutaneous ureterostomy were performed. Pathological findings showed prostatic acinar carcinoma and prostatic duct carcinoma mimicking TCC, and PSA immunohistochemically weak positive. The final diagnosis was prostate cancer consisting of acinar and ductal component. Adjuvant hormonal therapy was performed, but was ineffective. The patient died 2.5 months after operation. We reviewed and discussed 66 cases of prostatic duct carcinoma, including our case, in the Japanese literature.