经尿道前列腺切除术中偶然发现的前列腺癌。

Prostate cancer as incidental finding in transurethral resection.

作者信息

Dellavedova Tristán, Ponzano Rolando, Racca Laura, Minuzzi Federico, Domínguez Mariana

机构信息

Fundación Urológica Córdoba para la Docencia e Investigación Médica, Córdoba, Argentina.

出版信息

Arch Esp Urol. 2010 Dec;63(10):855-61.

PMID:21187568

Abstract

UNLABELLED

Prostate adenocarcinoma is found in surgical samples without prior diagnosis in 4 to 15% of the patients. In some of them, there is previous suspicion but in others this finding is completely incidental. We present 7 cases of prostate cancer detected in 100 patients who underwent bipolar transurethral resection (TUR) of the prostate due to regular indications. The aim of this paper is to describe patient's characteristics, postoperative outcome, analyze TURP as a diagnostic tool and evaluate therapeutic options for prostate cancer (PCa).

METHODS

One hundred patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH) underwent TURP in FUCDIM between June 2007 and August 2009. In 7 of them, prostate adenocarcinomas were detected. None of the patients underwent TURP only because of increased prostate-specific antigen (PSA).

RESULTS

Mean preoperative PSA was 7.6 ng/ml (r= 0.72 -27 ng/ml), 39% of the patients had PSA < 4 ng/ml; 33 (40%) had undergone previous biopsies and 36% of them had 2 or more previous biopsies. Prostate cancer detection global rate was 7%, 3 cases were incidental findings (low PSA and low-risk tumors), 3 patients had increased PSA and several previous biopsies with negative results and 1 had low PSA and aggressive tumor (Gleason 4+3).

CONCLUSIONS

TURP patients with prostate cancer are a heterogeneous group. TURP can be both diagnostic and therapeutic when facing patients with obstructive symptoms, high PSA and negative prostate biopsies. There are several therapeutic alternatives for TURP patients with cancer, taking into consideration tumor grade and stage, age, life expectancy and will of the patient. Bipolar TUR, in selected patients, allows to offer optional active surveillance (in these patients PSADT is very useful) and if cancer is not found, it eases the follow up of these patients. Active treatment (surgery or radiotherapy) is indicated in T1a patients with life expectancy longer than 10 years, and in the majority of T1b patients.

摘要

未标注

在未经事先诊断的手术样本中，4%至15%的患者被发现患有前列腺腺癌。其中一些患者此前已有怀疑，但另一些患者的这一发现完全是偶然的。我们报告了在100例因常规指征接受前列腺双极经尿道切除术（TUR）的患者中发现的7例前列腺癌病例。本文旨在描述患者特征、术后结果，分析经尿道前列腺切除术（TURP）作为一种诊断工具，并评估前列腺癌（PCa）的治疗选择。

方法

2007年6月至2009年8月期间，100例因良性前列腺增生（BPH）导致膀胱出口梗阻的患者在FUCDIM接受了TURP。其中7例患者被检测出患有前列腺腺癌。没有患者仅因前列腺特异性抗原（PSA）升高而接受TURP。

结果

术前平均PSA为7.6 ng/ml（范围=0.72 - 27 ng/ml），39%的患者PSA<4 ng/ml；33例（40%）患者此前接受过活检，其中36%的患者有过2次或更多次活检。前列腺癌的总体检出率为7%，3例为偶然发现（PSA低且肿瘤风险低），3例患者PSA升高且此前多次活检结果为阴性，1例患者PSA低但肿瘤侵袭性强（Gleason评分4+3）。

结论

患有前列腺癌的TURP患者是一个异质性群体。当面对有梗阻症状、PSA高且前列腺活检阴性的患者时，TURP既可以作为诊断手段，也可以作为治疗手段。对于患有癌症的TURP患者，考虑到肿瘤分级和分期、年龄、预期寿命以及患者意愿，有多种治疗选择。对于部分患者，双极TUR允许进行选择性主动监测（在这些患者中，PSA倍增时间非常有用），如果未发现癌症，则便于对这些患者进行随访。预期寿命超过10年的T1a患者以及大多数T1b患者需要进行积极治疗（手术或放疗）。