以直肠癌症状为表现的前列腺癌诊疗体会及文献复习

目的 探讨以直肠癌症状为表现的前列腺癌诊治要点。方法 回顾性分析我院诊治的3例以直肠癌症状为表现的前列腺癌患者临床病理特征、随访情况，总结现有文献讨论诊治心得。结果 3例患者均是因胃肠道症状至本院胃肠外科就诊，患者2直肠指检未见异常，患者1和患者3直肠指检均可触及肿物；CT及MRI均可见肿物累及前列腺和直肠；肠镜见环周肿物，肠腔狭窄；组织学为高/低分化腺癌；所有患者初步诊断均为直肠癌。患者1血清PSA:2.532 ng/ml，行Miles术，术后Gleason评分：5+4=9，免疫组化：PSA/P504s（+），最终确诊为前列腺癌，术后追加内分泌治疗。患者2和患者3在泌尿外科会诊后，血清PSA分别为>100 ng/ml和153.49 ng/ml,Gleason评分分别为5+3=8和4+3=7，免疫组化PSA/P504s均为（+），确诊为前列腺癌，进行了内分泌治疗和全盆腔脏器切除。结论 前列腺癌诊断应结合病史、检查、组织学及免疫组织化学，警惕误诊。

Diagnosis and treatment of prostate cancer with rectal cancer symptoms and literatures review

ObjectiveTo investigate the diagnosis and treatment of prostate cancer with rectal cancer symptoms. MethodsThe data of 3 cases of prostate cancer with rectal cancer symptoms in our hospital were analyzed retrospectively. ResultsAll 3 patients were admitted to the gastrointestinal department of our hospital due to gastrointestinal symptoms. Patient 2: digital rectal examination showed no abnormality, digital rectal examination was able to touch the mass in both patients 1 and 3. Both CT and MRI showed masses involving the prostate and rectum,colonoscopy showed a circumferential mass with a narrow lumen,the histology is high/low differentiated adenocarcinoma,all patients were initially diagnosed with rectal cancer.The patient 1 serum PSA:2.532 ng/ml, Miles surgery was performed, Gleason: 5+4=9 after surgery, immunohistochemistry: PSA/P504s (+), finally diagnosed as prostate cancer, and postoperative endocrine therapy was added.After urological consultation, serum PSA of patient 2 and patient 3 were >100 ng/ml and 153.49 ng/ml, Gleason scores were 5+3=8 and 4+3=7, respectively, and immunohistochemical PSA/P504s were (+). Finally, prostate cancer was diagnosed, and endocrine therapy and total pelvic organ resection were used for treatment. ConclusionThe diagnosis of prostate cancer should be combined with medical history, various examinations, histology and immunohistochemistry, and avoided wrong treatment.