低血清前列腺特异抗原型高危前列腺癌的临床特征

目的:提高对低血清前列腺特异抗原(PSA)型高危前列腺癌的认识及诊疗水平。方法:回顾分析8例低PSA型高危前列腺癌患者的临床资料。结果:8例患者入院平均PSA值为2.14ng/mL;7例患者肛指检查异常;穿刺病理诊断腺癌6例(其中1例为导管腺癌),小细胞癌2例;行Gleason评分者5例,均>7分;T3期以上患者占75%,5例有远处转移。对2例前列腺小细胞癌行内分泌治疗,其中1例再行化疗;对6例前列腺癌,1例行内分泌治疗加根治性放疗,1例行前列腺癌根治术加内分泌辅助治疗,其余4例均行内分泌治疗。平均随访19.5个月,8例患者中3例死亡,4例病情进展,1例病情无进展。结论:低PSA型高危前列腺癌起病隐匿,恶性程度较高,诊断及监测不依赖于PSA,治疗效果不佳,需引起足够重视。

Clinical Features of High-Risk Prostate Cancer with Low Serum Levels of Prostate Specific Antigen

Objective：To investigate the clinical features of high-risk prostate cancer with low serum levels of prostate specific antigen（PSA）.Methods： Clinical data of eight patients with high-risk prostate cancer with low serum levels of PSA were analyzed retrospectively.The average serum PSA level in the eight patients was 2.14 ng/ml when they were admitted to hospital.Digital rectal examiniation showed abnormalties in seven patients.Pathological examination showed that two patients with small-cell carcinoma of prostate,one patient with ductal adenocarcinoma of prostate and five patients with normal acinar adenocarcinoma of the prostate.Five cases had been judged by Gleason grading system,and the scores were all higher than 7.The patients at clinical stage of T3 and T4 accounted for 75%,and distant metastases were found in five cases.Results： Two cases of small-cell carcinoma underwent endocrine therapy,and one of them also underwent chemical therapy.One case underwent radical radiation therapy and endocrine therapy.One case underwent radical prostatectomy and endocrine therapy.And the other four cases underwent endocrine therapy.Three patients died,four patients progressed and only one case remained stabe after a median follow-up period of 19.5 months.Conclusions： High-risk prostate cancer with low serum levels of PSA has an insidious onset of symptoms.Diagnosis and surveillance of this disease is not dependent on PSA and the prognosis is poor,so enough attention should be paid to this type of prostate cancer.