PSA正常的前列腺癌患者临床特点分析

目的:根据PSA低于4 ng/mL的前列腺患者的临床资料及随访情况,探讨此类前列腺癌患者的临床特点,对PSA正常的前列腺癌患者的诊断及治疗提供临床思路。方法:收集2013年01月至2018年01月西京医院及西安交通大学第二附属医院收治的35例PSA正常的前列腺癌患者的临床资料。观察此类患者的发病情况、临床就诊特征、病理学特征、危险程度分级、Gleason评分、治疗及预后。总结PSA正常的前列腺癌患者的临床诊断及治疗特征。结果:PSA正常的前列腺癌患者占同期确诊前列腺癌的5.72%。35例患者中,28例主要因为排尿困难为症状就诊,血清PSA 0.91~3.96 ng/mL,平均(2.73±0.77)ng/mL。f/tPSA>0.16为5例,占14.3%,前列腺体积平均值为(68.4±36.66)cm^(3),12例患者行磁共振检查,10例报告提示前列腺癌可能,2例报告为前列腺增生,未发现前列腺癌影像学证据。13例患者行B超引导下经直肠前列腺穿刺活检术,11例患者病理诊断为前列腺癌,2例患者未发现肿瘤证据。行经尿道前列腺电切术共24例,其中包括2例穿刺活检未发现肿瘤证据患者,并于术后12周行前列腺癌根治性手术。病理结果显示:29例为前列腺腺癌,2例为肉瘤,2例为小细胞癌,1例为鳞癌,1例为黏液腺癌。切缘阳性10例(28.6%),侵犯精囊9例(25.71%),淋巴结阳性13例(37.14%)。TNM分期:T期6例,T期10例,T期7例,T期12例。危险度分级:低危患者5例(14.28%),中危9例(25.71%),高危21例(60%)。Gleason评分7分以下为6例(20.69%),7分为9例(31.03%),7分以上为14例(48.28%)。随访时间13~72月,术后密切监测PSA水平,术后生化复发共13例(37.14%),21例患者死亡,16例为前列腺特异性死亡。术后1、2、3年的生存率分别为:97.14%,88.57%,77.14%。结论:PSA正常的前列腺癌因无明显的临床就诊特征,精囊侵犯检出率高、Gleason评分及危险程度均偏高,3年生存率仅为77.14%。对于此类患者,不应以惯性思维认为PSA水平低,临床风险小,应更积极的完善检查,调整治疗策略,给此类患者带来更多的生存获益。

Clinical characteristics analysis of prostate cancer with normal PSA level

Objective:According to the clinical data with PSA level lower than 4 ng/mL of prostate cancer patients and follow-up these patients,to explore the clinical characteristics of this kind of prostate cancer patients,and to provide ideas for the diagnosis and treatment of prostate cancer patients with normal PSA.Methods:The clinical data of 35 patients with normal PSA prostate cancer admitted to Xijing Hospital and the Second Affiliated Hospital of Xi'an Jiaotong University from January 2013 to January 2018 were collected.The incidence,clinical features,pathological features,risk grade,Gleason score,treatment and prognosis were observed.Objective to summarize the clinical diagnosis and treatment characteristics of normal PSA prostate cancer.Results:Normal PSA prostate cancer accounted for 5.72% of the total prostate cancer diagnosed in the same period.Of the 35 patients,28 were mainly diagnosed as dysuria.The serum PSA was 0.91~3.96 ng/mL,with an average of (2.73±0.77)ng/mL.f/tPSA>0.16 in 5 cases (14.3%),the average volume of prostate was (68.4±36.66)cm3,12 patients underwent MRI examination,10 cases reported possible prostate cancer,2 cases reported benign prostatic hyperplasia,no imaging evidence of prostate cancer was found.Thirteen patients underwent transrectal prostate biopsy guided by B-ultrasound,11 patients were pathologically diagnosed as prostate cancer,and 2 patients had no evidence of tumor.Transurethral resection of the prostate was performed in 24 cases,including 2 cases with no evidence of tumor by biopsy,and radical prostatectomy was performed 12 weeks after operation.Pathological results showed that 29 cases of prostate adenocarcinoma,2 cases of sarcoma,2 cases of small cell carcinoma,1 case of squamous cell carcinoma,1 case of mucinous adenocarcinoma.There were 10 cases (28.6%) with positive margin,9 cases (25.71%) with seminal vesicle invasion,and 13 cases (37.14%) with positive lymph nodes.TNM stage:6 cases of T2a,10 cases of T2b,7 cases of T2C,12 cases of T3-4.Risk classification:Low risk patients 5 cases (14.28%),medium risk 9 cases (25.71%),high risk 21 cases (60%).Gleason score was below 7 in 6 cases (20.69%),7 in 9 cases (31.03%),and above 7 in 14 cases (48.28%).During the follow-up period of 13~72 months,PSA levels were closely monitored.Among which there were 13 cases (37.14%) of biochemical recurrence after operation,21 cases died and 16 cases died of prostate-specific.The 1-,2-,3-year survival rates were 97.14%,88.57%,77.14%.Conclusion:Normal PSA prostate cancer has no obvious clinical features,but high detection rate of seminal vesicle invasion,high Gleason score and high risk,the 3-year survival rate of normal PSA prostate cancer was only 77.14%.For these patients,we should not think that the level of PSA is low and the clinical risk is small.We should actively improve the examination and adjust the treatment strategy to bring more survival benefits to these patients.