以骨转移癌为首发表现的前列腺癌诊治分析

目的:对以骨转移癌为首发表现的前列腺癌患者进行分析，提高对晚期前列腺癌的认识。方法:对32例以骨转移癌为首发表现的前列腺癌患者症状与体征、实验室检查、影像学检查、病理学检查结果等资料进行回顾分析。结果:32例患者表现为骨痛25例(78.13%),凝血功能障碍、贫血10例(31.25%)，发热2例(6.25%)，伴有泌尿系统症状8例(25%),血清前列腺特异性抗原(PSA):PSA>50ng/ml者15例,PSA>100ng/ml者8例,碱性磷酸酶升高(超过150U/L)13例(72%)。进一步行骨核素扫描见多发、散在、无规律的放射性增高或浓聚灶，骨转移瘤见于腰骶椎体、髋骨占30例（93.75%）,其次为肋骨和胸骨，伴一处或以上的脏器转移占6例(18.75%)。追问病史发现前列腺癌诊断线索8例。经前列腺穿刺活组织检查确诊前列腺癌22例，临床诊断10例。结论:对于临床上出现不明原因骨痛、凝血功能障碍、贫血、发热等症状的老年男性患者,应考虑到前列腺癌伴骨转移可能,应常规查血PSA，据情行骨扫描及骨髓活检等检查。

Clinical analysis of bone metastasis related symptom as the first manifestation in prostate cancer

Objective:To improve the understanding of prostate cancer by analysis of the bone metastasis related symptom as the first manifestation in prostate cancer. Methods:To retrospectively study the symptoms,physical sign, laboratory test,image files of the prostate cancer with bone metastasis related symptom as the first manifestation. Re-sults:All 32 cases with metastatic carcinoma of bone were collected. Twenty - five of them with ostalgia were found, ten of them with disorder of congraution or anaemia and two with low fever. Eight victims had urology symptom,the prostate - specific antigen(PSA)raised which more than 50ng/ ml in fifteen patients,and more than 100ng/ ml in eight cases. The alkaline phosphatase(ALP)raised in thirteen cases(more than 150U/ L). Furthermore,with the ex-am completed gradually,the bone metastasis were found all of them and most of the main destruction were found at the sacroiliac joint,hip joint and iliac bone. These were followed at ribs and sternum. More than one organ metastases had six victims. Eight of all cases were found the prostate cancer related symptoms. Twenty - two of them were diagnosed definitely by biopsy of histology,ten of them were diagnosed by clinic. Conclusion:Prostate cancer combine with osse-ous metastasis may be found from the old man with unreasonable symptom like bone ache,disorder of congraution,an-sima,fever,and so on. And then PSA should be examed,bone ECT and biosphy of bone or prostate are needed.