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。

Application value of diagnostic TURP for patients with serum PSA abnormality

Abstract] Objective： To assess the application value of diagnostic transurethral resection of the prostate （TURP） for benign prostatic hyperplasia （BPH） patients with persistently abnormal serum PSA levels. Methods： We performed TURP for 71 BPH pa- tients with the PSA level 〉 4 μg/L, and analyzed the Gleason scores and prognosis of the cases pathologically confirmed as prostate cancer （PCa）. We conducted follow-up visits to all the patients, obtained the PSA levels and International Prostate Symptom scores （IPSS） at 6 and 12 months after TURP, analyzed their changes and assessed the value of TURP in the diagnosis and treatment of BPH with serum PSA abnormality. Results ： Among the 40 patients with negative prostate biopsy and persistent serum PSA abnormality, 2 cases were diagnosed as Gleason score 6 prostatic adenocarcinoma by TURP biopsy, and 1 case as Gleason score 6 PCa by repeated biopsy. All the 3 patients underwent radical prostatectomies and were well recovered during the follow-up visits. Of the 31 patients who had refused biopsy, 9 cases were confirmed by postoperative pathology as Gleason score 7 -9 PCa, 1 treated by radical prostatectomy and the other 8 by endocrine therapy. Another 59 cases were pathologically diagnosed as BPH, of which, the serum PSA level was restored to normal in 56 and significantly reduced in the other 3, and IPSS was remarkably increased in 53 and improved in the other 6 following urethral soundings. Conclusion ： Diagnostic TURP can increase the early diagnosis rate of PCa, improve lower urinary tract symptoms （LUTS） and help to normalize the serum PSA level. Therefore, it can be chosen for those with persistent serum PSA abnor- mality, LUTS and negative prostate biopsy. Natl J Atutrol, 2013, 19 （11） ： 999 -1002