Chokkalingam Anand P, Nyrén Olof, Johansson Jan-Erik, Gridley Gloria, McLaughlin Joseph K, Adami Hans-Olov, Hsing Ann W
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20892, USA.
Cancer. 2003 Oct 15;98(8):1727-34. doi: 10.1002/cncr.11710.
Pathologically, benign prostatic hyperplasia (BPH) is not considered a precursor for prostate carcinoma. However, because the two conditions share not only a similar hormonal environment within the prostate but also several common risk factors, it is possible that men with BPH may be at increased risk of prostate carcinoma due to these shared factors.
To elucidate this further, the authors used Swedish nationwide population-based record-linkage data to assess prostate carcinoma risk up to 26 years after the diagnosis of BPH among 86,626 men.
Overall, relative to the general population, patients with BPH experienced little, if any, excess risk of prostate carcinoma (2% excess incidence after 10 years of follow-up). However, patients with BPH with and without surgical intervention experienced different prostate carcinoma risk patterns. Those undergoing transvesicular adenomectomy had a significant 22% lower incidence and a 23% lower mortality after the first 5 years of follow-up and those undergoing transurethral resection had a significant 10% higher incidence but a 17% lower mortality. In contrast, after the first 5 years, patients with BPH who did not receive surgical intervention experienced significant excesses of both prostate carcinoma incidence (18%) and mortality (77%).
The differences in prostate carcinoma incidence and mortality by BPH treatment type suggest that factors related to treatment or health reasons underlying the selection of treatment influence subsequent prostate carcinoma risk. Further studies are needed to confirm the minimal excess risk of prostate carcinoma among BPH patients overall and the possible impact of BPH treatment methods on subsequent prostate carcinoma risk.
从病理学角度来看，良性前列腺增生（BPH）不被视为前列腺癌的前驱病变。然而，由于这两种病症不仅在前列腺内共享相似的激素环境，而且存在若干共同的风险因素，因此患有BPH的男性可能由于这些共同因素而患前列腺癌的风险增加。
为了进一步阐明这一点，作者使用瑞典全国基于人群的记录链接数据，对86626名男性在诊断为BPH后长达26年的前列腺癌风险进行评估。
总体而言，相对于普通人群，BPH患者患前列腺癌的风险即使有增加也微乎其微（随访10年后发病率仅高出2%）。然而，接受和未接受手术干预的BPH患者经历了不同的前列腺癌风险模式。接受经膀胱腺瘤切除术的患者在随访的前5年后发病率显著降低22%，死亡率降低23%；接受经尿道切除术的患者发病率显著高出10%，但死亡率降低17%。相比之下，在最初5年后，未接受手术干预的BPH患者前列腺癌发病率（18%）和死亡率（77%）均显著增加。
BPH治疗类型导致的前列腺癌发病率和死亡率差异表明，与治疗相关的因素或治疗选择背后的健康原因会影响后续前列腺癌风险。需要进一步研究来确认总体上BPH患者患前列腺癌的最低额外风险以及BPH治疗方法对后续前列腺癌风险的可能影响。
