Nafie Shady, Dormer John, Khan Masood A
Department of Urology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
Int Urol Nephrol. 2017 Aug;49(8):1343-1346. doi: 10.1007/s11255-017-1617-8. Epub 2017 May 15.
Monopolar transurethral resection of the prostate is the gold standard for the treatment of benign prostatic hyperplasia. However, due to the associated risks of bleeding and TUR syndrome, laser prostate surgery is gaining popularity. We perform thulium-laser vaporesection of the prostate (TmLRP), where histological samples are generated in every case. We determined postoperative incidence and significance of prostate cancer detection, by retrospective histological examination of our cases.
Between October 2006 and August 2012, 223 patients underwent TmLRP by a single surgeon in our institution. With a background of a benign DRE, and no suspicion of CaP, histological results were studied.
Mean age was 71 years (range 46-91), mean PSA was 4.1 ng/mL (range 0.1-20). 4.9% (11/223) had cancer prostate (CaP) diagnosed, with mean PSA of 6.9 ng/mL (range 0.7-14). Of these: 91% (10/11) had pT1b disease while 9% (1/11) had pT1a disease. Gleason score was 6 in 28% (3/11); 7 in 36% (4/11); 8 in 18% (2/11); 9 in and 18% (2/11).
4.9% of patients had unexpected CaP, with significant disease in 4.4% (pT1b) and 3.6% (Gleason score ≥7). Hence, patients should be advised of the small risk of missing significant unsuspected CaP after laser prostatectomy.
经尿道前列腺单极切除术是治疗良性前列腺增生的金标准。然而，由于存在出血和经尿道电切综合征等相关风险，激光前列腺手术越来越受欢迎。我们开展了前列腺铥激光汽化切除术（TmLRP），每例手术均获取组织学样本。我们通过对病例进行回顾性组织学检查，确定前列腺癌检测的术后发生率及意义。
2006年10月至2012年8月期间，我们机构的一名外科医生为223例患者实施了TmLRP。在直肠指检结果为良性且无前列腺癌怀疑的背景下，对组织学结果进行研究。
平均年龄为71岁（范围46 - 91岁），平均前列腺特异抗原（PSA）为4.1 ng/mL（范围0.1 - 20）。4.9%（11/223）被诊断为前列腺癌（CaP），平均PSA为6.9 ng/mL（范围0.7 - 14）。其中：91%（10/11）为pT1b期疾病，9%（1/11）为pT1a期疾病。Gleason评分方面，28%（3/11）为6分；36%（4/11）为7分；18%（2/11）为8分；18%（2/11）为9分。
4.9%的患者存在意外的CaP，4.4%（pT1b期）和3.6%（Gleason评分≥7）为显著疾病。因此，应告知患者激光前列腺切除术后漏诊显著未被怀疑的CaP的小风险。
