Yang Xin-Yu, Xia Tong-Li, He Qun, Li Wen, Wang Jing-Hua, Su Jin-Wei, Li Jun, Na Yan-Qun
Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2007 Oct 9;87(37):2632-4.
To investigate the morbidity and pathological features of incidental prostate cancer and their clinical significance.
1483 prostate specimens obtained during operation, including transurethral resection of prostate (TURP) and total resection of the prostate, for the diagnoses of benign prostatic hypertrophy (BPH) or bladder cancer between January 1999 and August 2005 underwent pathological examination and 34beta12 and p63 immunohistochemical staining so as to detect incidental prostate cancer. The volume of incidental prostate cancer was calculated by the image analysis system. The clinical data were analyzed retrospectively. Comparison between the clinical and pathological feature of incidental prostate cancer was made.
53 cases of incidental prostate cancer, with the Gleason scores from 2 (1+1) to 9 (4+5) and the volumes from 0.18 to 1440.00 mm(3) were detected. The morbidity of incidental prostate cancer was 3.6%. The volume of 47 cases (88.7%) were less than 0.5 cm(3) as the threshold of insignificant cancer, and the volumes of 6 cases (11.3%) were more than 0.5 cm(3). All incidental prostate cancers of clinical significance were detected in the TURP samples. Among the incidental prostate cancers found in the TURP samples 20% were clinically significant cancers. The clinically significant incidental cancers were located in the central or transitional zone with the Gleason scores of 3 + 4 (2 cases), 4 + 2 (1 case), or 4 + 5 (3 cases). These clinically significant cancers were of diffuse distribution, and their preoperative clinical features were negative in palpation/image examination, elevation of serum PSA, and negative in puncture examination.
Nowadays, the morbidity of incidental prostate cancer is lower than that of 1980s'. Among the incidental cancers 11.3% were of clinical significance. That the preoperative clinical examination cannot find these clinical significant cancers is partially caused by the pathological features of these tumors.
探讨偶发前列腺癌的发病率、病理特征及其临床意义。
对1999年1月至2005年8月期间因良性前列腺增生（BPH）或膀胱癌行手术切除的1483份前列腺标本（包括经尿道前列腺切除术（TURP）和前列腺全切除术）进行病理检查及34β12和p63免疫组化染色，以检测偶发前列腺癌。采用图像分析系统计算偶发前列腺癌的体积。对临床资料进行回顾性分析。比较偶发前列腺癌的临床和病理特征。
共检测出53例偶发前列腺癌，Gleason评分2（1+1）至9（4+5），体积0.18至1440.00mm³。偶发前列腺癌的发病率为³.⁶%。以0.5cm³作为微小癌的阈值，47例（88.7%）体积小于0.5cm³，6例（11.3%）体积大于0.5cm³。所有具有临床意义的偶发前列腺癌均在TURP标本中检出。在TURP标本中发现的偶发前列腺癌中，20%为具有临床意义的癌症。具有临床意义的偶发癌位于中央或移行区，Gleason评分为3+4（2例）、4+2（1例）或4+5（3例）。这些具有临床意义的癌症呈弥漫性分布，术前临床特征为触诊/影像学检查阴性、血清PSA升高及穿刺检查阴性。
目前，偶发前列腺癌的发病率低于20世纪80年代。在偶发癌中，11.3%具有临床意义。术前临床检查未能发现这些具有临床意义的癌症，部分原因是这些肿瘤的病理特征。
