Ramírez-Backhaus M, Trassierra M, Pontones J L, Luján S, DiCapua C, Rabenalt R, Stolzenburg J U, Jiménez Cruz F
Servicio de Urología, Hospital Universitario La Fe, Valencia.
Actas Urol Esp. 2008 Oct;32(9):873-8. doi: 10.1016/s0210-4806(08)73954-8.
Radical prostatectomy represents a standard surgical treatment for clinically localized prostate cancer. Classically pathologist and urologist worried about positive surgical margin, but not to the presence of surgery residual hyperplastic cells able to generate prostate specific antigen (PSA) and difficult the follow up of the patients that underwent surgery. We reviewed the literature looking for the incidence, the potential etiology and the influence of these hyperplastic cells in the biochemical evolution of the disease.
The information for this review was compiled by searching the Pubmed database. We used "Mesh", Prostatectomy" and "Prostatic Neoplasms" and "Prostate-Specific Antigen" terms, and we added "biochemical failure" and/or "hyperplasic cells" and/or "benign cells". Furthermore, we select the work in English, Spanish and German, review articles that referenced this work and include the series with more than 50 patients, letters to the editor, editorials and overall reviews.
Benign hyperplasic cells left behind after radical prostatectomy are frequent and probably under-rated. The influence of those cells in the biochemical outcome is a controversial issue. Positive margins for benign cells can come from apex or neck of the bladder, where the prostatic capsule is not well defined, but no from dorso-lateral area, this would imply a technical mistake. We recommend the inspection of the specimen by the surgeon, after prostatectomy in order to detect apex integrity, cranial and dorso-lateral capsule.
根治性前列腺切除术是临床局限性前列腺癌的标准外科治疗方法。传统上，病理学家和泌尿科医生关注手术切缘阳性，但并不关注手术残留的能够产生前列腺特异性抗原（PSA）的增生细胞，这使得接受手术的患者的随访变得困难。我们回顾了文献，以寻找这些增生细胞的发生率、潜在病因及其在疾病生化演变中的影响。
本综述的信息通过搜索PubMed数据库汇编而成。我们使用了“Mesh”、“前列腺切除术”、“前列腺肿瘤”和“前列腺特异性抗原”等术语，并添加了“生化失败”和/或“增生细胞”和/或“良性细胞”。此外，我们选择了英文、西班牙文和德文的文献，参考了引用该文献的综述文章，并纳入了患者超过50例的系列研究、给编辑的信、社论和综合评论。
根治性前列腺切除术后留下的良性增生细胞很常见，可能被低估了。这些细胞对生化结果的影响是一个有争议的问题。良性细胞的阳性切缘可能来自膀胱尖部或颈部，此处前列腺包膜不明确，但不会来自背外侧区域，这可能意味着技术失误。我们建议外科医生在前列腺切除术后检查标本，以检测尖部完整性、头侧和背外侧包膜。
