Thomas Anil A, Rosenblatt Steven, Wachterman Jared, Liao Wei, Moussa Ayman, Ponsky Lee E, Jones J Stephen
Glickman Urological and Kidney Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
J Am Coll Surg. 2009 Sep;209(3):371-6. doi: 10.1016/j.jamcollsurg.2009.05.015.
Preperitoneal placement of mesh during herniorraphy has been shown to complicate future extirpative prostate surgery. We investigated the value of a prostate cancer screening program in patients considering laparoscopic inguinal herniorrhaphy to identify men at risk of prostate cancer.
A prospective cohort study was conducted in men 30 years of age or older presenting with inguinal hernia. All patients were counseled on prostate cancer risk and the potential for herniorrhaphy with mesh placement to complicate future pelvic surgery. Serum prostate specific antigen (PSA) values were obtained, and patients determined to be at increased relative risk of prostate cancer were referred for urologic evaluation. Transrectal ultrasonography-guided biopsy was performed if clinically indicated, and operative data for patients undergoing prostate cancer treatment were retrospectively reviewed.
There were 1,324 patients who presented for management of inguinal hernia; 814 of these (median age 60 years) consented to screening. Overall, 259 (32%) had an increased relative risk of prostate cancer based on PSA 1.0 to 2.49 ng/mL, and 152 (19%) had PSA > or = 2.5 ng/mL. Transrectal ultrasonography-guided biopsy was performed in 86 patients. Prostate cancer was identified on initial or repeat biopsy in 31 patients (3.8%), including 1 patient (0.7%) younger than 50 years of age.
We found the incidence of concurrent prostate cancer with hernia to be low, but 51% of men had PSA values that suggested an increased relative risk of future development of prostate cancer. Men at increased risk of prostate cancer should be made aware of the impact that mesh might have on subsequent treatment options before mesh placement.
疝修补术中腹膜前放置补片已被证明会使未来的前列腺根治性手术变得复杂。我们研究了前列腺癌筛查项目在考虑行腹腔镜腹股沟疝修补术患者中的价值，以识别有前列腺癌风险的男性。
对30岁及以上患有腹股沟疝的男性进行了一项前瞻性队列研究。所有患者均接受了前列腺癌风险咨询以及补片放置疝修补术使未来盆腔手术复杂化的可能性。获取血清前列腺特异性抗原（PSA）值，确定前列腺癌相对风险增加的患者被转诊进行泌尿外科评估。如有临床指征，则进行经直肠超声引导下活检，并对接受前列腺癌治疗患者的手术数据进行回顾性分析。
共有1324例患者前来接受腹股沟疝治疗；其中814例（中位年龄60岁）同意进行筛查。总体而言，259例（32%）基于PSA 1.0至2.49 ng/mL前列腺癌相对风险增加，152例（19%）PSA≥2.5 ng/mL。86例患者进行了经直肠超声引导下活检。31例患者（3.8%）在初次或重复活检时确诊为前列腺癌，其中包括1例年龄小于50岁的患者（0.7%）。
我们发现疝合并前列腺癌的发病率较低，但51%的男性PSA值提示未来发生前列腺癌的相对风险增加。在放置补片之前，应让前列腺癌风险增加的男性了解补片可能对后续治疗选择产生的影响。
