Liedberg Fredrik, Chebil Gunilla, Månsson Wiking
Växjö County Hospital, Department of Surgery Section of Urology, 351 85 Växjö, Sweden.
Expert Rev Anticancer Ther. 2007 Mar;7(3):383-90. doi: 10.1586/14737140.7.3.383.
We reviewed the literature on urothelial carcinoma in the prostatic urethra and prostate. We concluded that the incidence of urothelial carcinoma in the prostatic urethra and prostate is probably underestimated. This fact warrants thorough follow-up of patients with high-risk bladder cancers and also whole-mount examination of the prostate after cystectomy to recognize the true incidence and extent of such tumor involvement. Resectoscope loop biopsy is the method of choice to detect urothelial carcinoma in the prostatic urethra/prostate and such biopsies should include the area around the verumontanum to ensure optimal sensitivity. Carcinoma in situ in the prostatic urethra should be treated with intravesical Bacillus Calmette-Guérin and a transurethral resection of the prostate prior to that treatment might increase the contact of Bacillus Calmette-Guérin with the prostatic urethra, improve staging and in itself treat the prostatic involvement. Conservative treatment of carcinoma in situ in the prostatic ducts is an option, although radical surgery is probably best for treating extensive intraductal involvement, since data on the former strategy are inconclusive. Patients with stromal invasion should undergo radical surgery. It is necessary to take the route of prostatic involvement into account when estimating prognosis in each individual patient, since contiguous growth into the prostate is associated with worse prognosis. Prospective studies using a whole-mount technique to investigate the prostate are needed to clarify both the role of different routes of prostate invasion and the prognostic significance of different degrees of prostate invasion. At cystectomy, when urothelial carcinoma is present in the prostatic urethra and/or prostate, it is necessary to balance the risk of urethral recurrence and decreased sexual function against opinion and expectations expressed by the patient during preoperative counseling regarding urinary diversion and primary urethrectomy.
我们回顾了有关前列腺尿道和前列腺尿路上皮癌的文献。我们得出结论，前列腺尿道和前列腺尿路上皮癌的发病率可能被低估了。这一事实使得有必要对高危膀胱癌患者进行全面随访，并且在膀胱切除术后对前列腺进行整体检查，以了解此类肿瘤累及的真实发病率和范围。经尿道电切镜环形活检是检测前列腺尿道/前列腺尿路上皮癌的首选方法，此类活检应包括精阜周围区域，以确保最佳敏感性。前列腺尿道原位癌应采用膀胱内卡介苗治疗，在此治疗之前进行经尿道前列腺切除术可能会增加卡介苗与前列腺尿道的接触，改善分期，并本身治疗前列腺受累情况。前列腺导管原位癌的保守治疗是一种选择，尽管根治性手术可能是治疗广泛导管内受累的最佳方法，因为关于前一种策略的数据尚无定论。有间质浸润的患者应接受根治性手术。在评估每个患者的预后时，有必要考虑前列腺受累的途径，因为向前列腺的连续生长与更差的预后相关。需要采用整体技术对前列腺进行前瞻性研究，以阐明前列腺不同浸润途径的作用以及不同程度前列腺浸润的预后意义。在膀胱切除术中，当前列腺尿道和/或前列腺存在尿路上皮癌时，有必要在尿道复发风险和性功能下降与患者在术前咨询中关于尿流改道和原发性尿道切除术所表达的意见和期望之间进行权衡。
