Ajape Abdulwahab A, Ibrahim Kazeem O O, Fakeye John A, Abiola Olusegun O
Division of Urology, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Ann Afr Med. 2010 Jul-Sep;9(3):113-7. doi: 10.4103/1596-3519.68353.
To review our experience with cancer of prostate management, highlighting the mode of presentation, method of diagnosis, and the treatment outcome.
Medical records of patients managed for cancer of prostate were retrospectively reviewed over a 10-year period. Relevant information which included the year of diagnosis, age at presentation, mode of presentation, digital rectal examination (DRE) findings, ultrasound (USS) assessment of the prostate, the prostate-specific antigen (PSA) value, the histology report, treatment offered and the outcome were extracted. Data were analyzed with SPSS version 11 software.
A total of 192 patients were managed for cancer of prostate within the study period but only 90 case notes were available for analysis. There was a 7.7 fold increase in the incidence of cancer of prostate. The mean age (+/-SD) at presentation was 68.4 (+/-10.1) years with an age range of 47-91 years and the peak incidence occurred in the seventh and eighth decades of life. The mean duration of symptoms prior to presentation was 10.3 (+/-17.1) months. A total of 66.7% of cases presented within 6 months of the onset of symptoms as against 14.4% of cases presented after a year. Majority of cases (88.9%) presented as locally advanced or metastatic disease and only 4.4% of cases were found incidentally. Only 38.9% had histologic confirmation of the diagnosis before management was instituted. DRE gave a false negative finding in 28.6% in this study. The sensitivity and false negative value of USS was 50% each and 3.3% had PSA within normal value. Bilateral orchidectomy was offered to 64 of 90 (71.1%) and the cancer related death (CRD) was 15.6%. The maximum follow-up period was 36 months in this study and 36.9% are still attending follow-up clinic.
There was an apparent increase in the incidence of cancer of prostate from the present study with majority still presenting with advanced disease. The sensitivity of DRE was high; this probably accounted for the treatment without establishing the histologic diagnosis in majority of the cases. Such a practice of clinical diagnosis alone should be discouraged.
回顾我们在前列腺癌管理方面的经验，重点介绍其临床表现方式、诊断方法及治疗结果。
回顾性分析10年间前列腺癌患者的病历。提取相关信息，包括诊断年份、就诊年龄、临床表现方式、直肠指检（DRE）结果、前列腺超声（USS）评估、前列腺特异性抗原（PSA）值、组织学报告、所提供的治疗及结果。使用SPSS 11版软件进行数据分析。
研究期间共管理了192例前列腺癌患者，但仅有90份病历可供分析。前列腺癌发病率增加了7.7倍。就诊时的平均年龄（±标准差）为68.4（±10.1）岁，年龄范围为47 - 91岁，发病高峰出现在70岁和80岁年龄段。就诊前症状的平均持续时间为10.3（±17.1）个月。66.7%的病例在症状出现后6个月内就诊，而14.4%的病例在1年后就诊。大多数病例（88.9%）表现为局部晚期或转移性疾病，仅4.4%的病例为偶然发现。在开始治疗前，只有38.9%的病例经组织学确诊。本研究中DRE的假阴性率为28.6%。USS的敏感性和假阴性值均为50%，3.3%的患者PSA值正常。90例患者中有64例（71.1%）接受了双侧睾丸切除术，癌症相关死亡率（CRD）为15.6%。本研究的最长随访期为36个月，36.9%的患者仍在随访门诊就诊。
本研究显示前列腺癌发病率明显上升，大多数患者仍表现为晚期疾病。DRE的敏感性较高；这可能是大多数病例在未确立组织学诊断的情况下就进行治疗的原因。应避免仅依靠临床诊断的这种做法。
