Bostwick D G, Cooner W H, Denis L, Jones G W, Scardino P T, Murphy G P
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
Cancer. 1992 Jul 1;70(1 Suppl):291-301. doi: 10.1002/1097-0142(19920701)70:1+<291::aid-cncr2820701317>3.0.co;2-4.
There are a number of similarities between benign prostatic hyperplasia (BPH) and cancer. Both display a parallel increase in prevalence with patient age according to autopsy studies (86.2% and 43.6%, respectively, by the ninth decade), although cancer lags by 15-20 years. Both require androgens for growth and development, and both respond to antiandrogen treatment regimens. Most cancers arise in prostates with concomitant BPH (83.3%), and cancer is found incidentally in a significant number of transurethral prostatectomy (TURP) specimens (10%). The clinical incidence of cancer arising in patients with surgically treated BPH is approximately 3%. BPH may be related to a subset of prostate cancer which arises in the transition zone, perhaps in association with atypical adenomatous hyperplasia (AAH). It is important to exclude cancer in patients presenting with symptoms of bladder outlet obstruction presumably due to BPH. For such patients, we recommend digital rectal examination (DRE) and, at least in high-risk patients, serum prostate specific antigen (PSA) determination. Transrectal ultrasound (TRUS) should be employed in patients with elevated PSA levels to determine the volume of the prostate, the relative contribution of BPH to volume, and the PSA density (ratio of PSA level to volume). Biopsy should be obtained from any area suspicious for cancer. Early detection and treatment of cancer when it is localized offers the greatest chance for cure.
良性前列腺增生（BPH）与癌症之间存在许多相似之处。根据尸检研究，二者的患病率均随患者年龄增长而呈平行上升趋势（到第九个十年时，分别为86.2%和43.6%），尽管癌症的上升滞后15 - 20年。二者的生长和发育都需要雄激素，且都对抗雄激素治疗方案有反应。大多数癌症发生在伴有BPH的前列腺中（83.3%），并且在大量经尿道前列腺切除术（TURP）标本中偶然发现癌症（10%）。接受手术治疗的BPH患者中癌症的临床发病率约为3%。BPH可能与起源于移行带的一部分前列腺癌有关，可能与非典型腺瘤样增生（AAH）有关。对于疑似因BPH出现膀胱出口梗阻症状的患者，排除癌症很重要。对于此类患者，我们建议进行直肠指检（DRE），并且至少在高危患者中进行血清前列腺特异性抗原（PSA）测定。PSA水平升高的患者应采用经直肠超声（TRUS）来确定前列腺体积、BPH对体积的相对贡献以及PSA密度（PSA水平与体积之比）。应从任何可疑癌症的区域获取活检组织。癌症局限时的早期检测和治疗提供了最大的治愈机会。
