钬激光前列腺剜除术与经尿道前列腺电切术治疗良性前列腺增生的前列腺癌诊断价值：一项回顾性对比研究。
The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study.
机构信息
Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Int J Surg. 2020 Jul;79:217-221. doi: 10.1016/j.ijsu.2020.05.025. Epub 2020 May 21.
BACKGROUND
To compare the diagnostic value of prostate cancer (PCa) between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP).
METHODS
We retrospectively analyzed the clinical data of 2909 patients who underwent surgery for benign prostatic hyperplasia (BPH) from January 2008 to June 2018. A total of 1362 patients received HoLEP, and 1547 patients received TURP. The baseline patient characteristics were collected. We then compared the perioperative outcomes of these patients who diagnosed with incidentally diagnosed prostatic carcinoma (IDPC) or PCa after BPH surgeries.
RESULTS
The total detection rate of PCa in HoLEP group was higher than that in TURP group (85/6.24% vs. 61/3.94%, p = 0.005). Specifically, 55(4.6%) patients were diagnosed with IDPC in HoLEP group with prostate-specific antigen (PSA) less than 4 ng/ml, and 37(2.7%) patients in TURP group (p = 0.014). For the patients with PSA between 4 and 10 ng/ml, 15(13.9%) patients were diagnosed with PCa after HoLEP, and 6(5.0%) patients after TURP (p = 0.023). But the detection rate of PCa was not significantly different between the two groups when PSA was over 10 ng/ml. On the other hand, 57 in 1215 patients with no prostate biopsy preoperatively were diagnosed with PCa after HoLEP, while 42 in 1370 patients after TURP (4.7% vs. 3.1%, p = 0.040), respectively. Twenty-six patients received once biopsy and diagnosed with PCa in HoLEP group, while 15 patients in TURP group (18.4% vs. 8.9%, p = 0.018), respectively. However, no significant difference was observed for patients who received twice prostate biopsy in the two groups.
CONCLUSIONS
The present study showed that HoLEP can provide a higher total detection rate of PCa when compared with TURP. Besides, this superiority was especially embodied in patients with PSA less than 10 ng/ml.
背景
比较经尿道前列腺钬激光剜除术（HoLEP）和经尿道前列腺电切术（TURP）治疗前列腺癌（PCa）的诊断价值。
方法
我们回顾性分析了 2008 年 1 月至 2018 年 6 月期间因良性前列腺增生（BPH）接受手术治疗的 2909 例患者的临床资料。其中 1362 例行 HoLEP，1547 例行 TURP。收集患者的基线特征，比较这些患者在诊断为偶然发现的前列腺癌（IDPC）或 PCa 后的围手术期结果。
结果
HoLEP 组 PCa 的总检出率高于 TURP 组（85/6.24%比 61/3.94%，p=0.005）。具体而言，HoLEP 组中前列腺特异性抗原（PSA）<4ng/ml 的 55（4.6%）例患者被诊断为 IDPC，TURP 组中有 37（2.7%）例（p=0.014）。对于 PSA 在 4-10ng/ml 之间的患者，HoLEP 术后有 15（13.9%）例被诊断为 PCa，TURP 术后有 6（5.0%）例（p=0.023）。但当 PSA 超过 10ng/ml 时，两组 PCa 的检出率无显著差异。另一方面，术前未行前列腺活检的 1215 例患者中，HoLEP 术后有 57 例被诊断为 PCa，而 TURP 术后有 42 例（4.7%比 3.1%，p=0.040）。HoLEP 组中有 26 例患者行单次活检被诊断为 PCa，TURP 组中有 15 例（18.4%比 8.9%，p=0.018）。然而，两组中接受两次前列腺活检的患者之间没有观察到显著差异。
结论
本研究表明，与 TURP 相比，HoLEP 可以提供更高的 PCa 总检出率。此外，这种优势尤其体现在 PSA 小于 10ng/ml 的患者中。
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