偶发性前列腺癌5例临床病理分析

目的探讨偶发性前列腺腺癌的发生率、临床及病理特点。方法收集40例复旦大学附属肿瘤医院因膀胱癌而行膀胱前列腺根治切除标本中偶然发现的前列腺腺癌5例,观察并分析其临床表现、病理学特点。结果临床表现:40例膀胱前列腺根治切除标本中有5例合并前列腺腺癌,发生率为12.5%(5/40)。患者平均年龄66岁(63～70岁)。4例表现为肉眼血尿,1例为镜下血尿。术前血PSA水平仅1例为6.55 ng/ml(参考值4.0 ng/ml),另外4例PSA水平均<4.0 ng/ml。病理检查:5例均为腺泡源性腺癌,4例Gleason分级评分均为6(3+3),1例Gleason分级评分为7(4+3)。临床病理TNM分期:3例为T1a,2例为T1b。结论前列腺癌可与尿路上皮癌合并发生,往往血PSA水平正常或稍高于正常。Gleason评分较低,癌灶常较局限,如取材不充分可能会漏诊。

Clinicopathological features of incidental prostate adenocarcinoma: an analysis of 5 cases

Purpose To review all relevant clinicopathological characteristics and incidence,of incidentally discovered prostate cancer(PCa) in patients undergoing radical cystoprostatectomy(RCP) for urothelial carcinoma of bladder.Methods Five male patients with incidentally prostatic adenocarcinoma underwent RCP in Fudan University Shanghai Cancer Center were collected.The clinicopathological features were reviewed.Results Clinical features of incidental PCa were observed in 5 of 40(12.5%) RCP specimens.The mean age of the five patients was 66 years(ranged from 63 to 70 years),four with complaint of gross hematuria,and one with intermittent microscopic hematuria.Only one of the 5 patients had preoperative PSA level ≥4 ng/ml(6.55 ng/ml).Pathological examination of the 5 cases showed prostate adenocarcinoma,Gleason grading scores were 6(3+3) in 4 cases,and 7(4+3) in one,and pTNM staging was T1a(3 cases) and T1b(2 cases).Conclusions Prostatic adenocaicoma can occur in combination with urothelial carcinoma.The PSA level usually is normal or a little higher.And the incidental prostate cancers are usually small in size,and Gleason grading score is lower.Therefore,our findings stress the need for a careful examination and complete excision of the prostate during RCP.