Orihuela E, Herr H W, Whitmore W F
Department of Surgery, University of Texas Medical Branch, Galveston.
Urology. 1989 Nov;34(5):231-7. doi: 10.1016/0090-4295(89)90314-2.
We reviewed 125 male patients treated with a six-week course of intravesical bacillus Calmette-Guerin (BCG) for superficial transitional cell cancer (TCC) of the bladder that was associated with mucosal involvement of the prostatic urethra in 15 cases. In 13 of these cases, there was a sustained complete response in both the bladder and the prostate. Among the other 110 patients, in 14 TCC developed in the prostate from one to fifty-three (mean 15) months after completion of BCG. Six of these 14 had had complete response in the bladder. Recurrent TCC in the prostate was seen in only 4 percent and 6 percent of patients who had prostatic urethritis on cystoscopy and prostatic granulomas on biopsy, respectively. In contrast, recurrence was observed in 14 percent of those without urethritis and in 44 percent of those without granulomas. Transurethral resection of the prostate (TURP) prior to BCG did not appear to influence tumor recurrence in the prostate. However, after BCG, 3 patients with recurrent TCC in the prostate had complete local response after TURP alone. Further, prostatic urethritis (73%) and prostatic granulomas (60%) were more frequent among patients who had TURP prior to BCG than in those without TURP (33% and 27%, respectively). Superficial TCC of the bladder associated with mucosal involvement of the prostatic urethra can be treated successfully with intravesical BCG. In addition, our results suggest that intravesical BCG has a prophylactic effect on tumor recurrence in the prostate, and that TURP may have an important role by removing present disease and by facilitating the development of an effective biologic response to BCG in the prostate. TCC in the prostate is a significant cause of relapse, and frequent surveillance of the prostatic urethra should be performed in conservatively treated patients with superficial bladder cancer.
我们回顾了125例接受为期六周的膀胱内卡介苗（BCG）治疗浅表性膀胱移行细胞癌（TCC）的男性患者，其中15例伴有前列腺尿道黏膜受累。在这些病例中，13例膀胱和前列腺均持续完全缓解。在其他110例患者中，14例在完成BCG治疗后1至53个月（平均15个月）前列腺出现TCC。这14例中有6例膀胱曾完全缓解。前列腺复发性TCC在膀胱镜检查有前列腺尿道炎和活检有前列腺肉芽肿的患者中分别仅占4%和6%。相比之下，无尿道炎患者中有14%复发，无肉芽肿患者中有44%复发。BCG治疗前经尿道前列腺切除术（TURP）似乎不影响前列腺肿瘤复发。然而，BCG治疗后，3例前列腺复发性TCC患者仅行TURP后即获得完全局部缓解。此外，BCG治疗前行TURP的患者中前列腺尿道炎（73%）和前列腺肉芽肿（60%）比未行TURP的患者更常见（分别为33%和27%）。与前列腺尿道黏膜受累相关的膀胱浅表性TCC可用膀胱内BCG成功治疗。此外，我们的结果表明，膀胱内BCG对前列腺肿瘤复发有预防作用，TURP可能通过清除现有疾病和促进前列腺对BCG产生有效的生物学反应而发挥重要作用。前列腺TCC是复发的重要原因，对于保守治疗的浅表性膀胱癌患者，应频繁监测前列腺尿道。
