实体器官受者中过度诊断的前列腺癌：过去 30 年的经验教训。
Over-diagnosed prostate cancer in solid organ recipients: lessons from the last 3 decades.
机构信息
Urology and Transplantation Department, CHU de Caen, CHU Côte de Nacre, Avenue de Côte de Nacre, 14033, Caen, France.
Hepatic and Transplantation Department, CHU de Caen, Caen, France.
出版信息
Int Urol Nephrol. 2021 Feb;53(2):241-248. doi: 10.1007/s11255-020-02636-2. Epub 2020 Sep 14.
INTRODUCTION
Prostate cancer (PC) is the most common neoplasia in men. With aging of solid organ transplant recipients (SOTR), its incidence is likely to increase. The aim of this study was to analyze PC screening results retrospectively in renal transplant recipients (RTR), hepatic transplant recipients (HTR) and cardiac transplant recipients (CTR).
PATIENTS AND METHODS
A retrospective monocentric study of PC diagnosed in renal, hepatic or cardiac transplanted patients since 1989 was performed. All the patients were followed annually by digital rectal examination and prostate serum antigen (PSA) dosage.
RESULTS
57 PC were diagnosed in 1565 SOTR male patients (3.6%): 35 RTR, 15 HTR, and 7 CTR. Standard incidence ratio (SIR) was 41.9. Mean age at the time of diagnosis was 64.5 (60.5-69.2). Mean time between transplantation and PC diagnosis was 95.7 (39.0-139.5) months. Median PSA rate was 7.0 (6.2-13) ng/mL. Clinical stages were T1, T2, and T3, respectively, for 29, 22 and 6 patients. Diagnosis was done by screening in 52 patients, after prostatitis in 1 and bone pain in another. Three PC were discovered on prostate chips after transurethral resection. Two patients were treated by active surveillance. 39 (68%) patients (25 RTR, 11 HTR and 3 CTR) were treated by radical prostatectomy. Histological results were 30 pT2 and 9 pT3 tumors, with 7 positive surgical margins. Gleason score was 5, 6, 7, 8 and 9 in, respectively, in 2, 24, 11, 1 and 1 patients. One patient with positive pelvic nodes was treated with hormonal therapy (HT). One had a biochemical relapse at 10 months and underwent salvage radiotherapy. Median follow-up was 85.2 months (46.1-115.0). 23 (40.4%) patients died. Two (3.6%) RTR and 1 (1.8%) CTR died from their PC. Standard incidence ratio were, respectively, 42.4, 48.2 and 39 in RTR, HTR and CTR.
CONCLUSION
Systematic screening in male SOTR after 50 years old could not be recommended. In the last 3 decades, we diagnosed too many low-risk prostate cancers strongly increasing the SIR but failing to decrease prostate cancer related mortality. SOTR should undergo individual screening with prior MRI when PSA rates are high. Management should not be different from that of the general population.
简介
前列腺癌（PC）是男性最常见的肿瘤。随着实体器官移植受者（SOTR）的老龄化，其发病率可能会增加。本研究的目的是回顾性分析肾移植受者（RTR）、肝移植受者（HTR）和心脏移植受者（CTR）中 PC 的筛查结果。
患者和方法
对 1989 年以来诊断为肾、肝或心脏移植患者的 PC 进行了回顾性单中心研究。所有患者均每年接受直肠指检和前列腺血清抗原（PSA）检测。
结果
在 1565 名 SOTR 男性患者中诊断出 57 例 PC（3.6%）：35 例 RTR、15 例 HTR 和 7 例 CTR。标化发病比（SIR）为 41.9。诊断时的平均年龄为 64.5（60.5-69.2）岁。从移植到 PC 诊断的平均时间为 95.7（39.0-139.5）个月。中位 PSA 率为 7.0（6.2-13）ng/mL。临床分期分别为 T1、T2 和 T3，分别为 29、22 和 6 例。52 例患者通过筛查诊断，1 例患者因前列腺炎，另 1 例患者因骨痛诊断。3 例 PC 在经尿道前列腺切除术（TURP）后通过前列腺芯片发现。2 例患者接受主动监测治疗。39 例（25 例 RTR、11 例 HTR 和 3 例 CTR）患者接受根治性前列腺切除术。组织学结果为 30 例 pT2 和 9 例 pT3 肿瘤，7 例有阳性手术切缘。Gleason 评分分别为 2、24、11、1 和 1 的患者各有 2 例、24 例、11 例、1 例和 1 例。1 例盆腔淋巴结阳性患者接受了激素治疗（HT）。1 例患者在 10 个月时出现生化复发，并接受挽救性放疗。中位随访时间为 85.2 个月（46.1-115.0）。23 例（40.4%）患者死亡。2 例（3.6%）RTR 和 1 例（1.8%）CTR 死于 PC。RTR、HTR 和 CTR 的标化发病比分别为 42.4、48.2 和 39。
结论
不建议对 50 岁以上的 SOTR 男性进行系统筛查。在过去的 30 年中，我们诊断出太多的低危前列腺癌，这极大地增加了 SIR，但未能降低前列腺癌相关死亡率。当 PSA 水平升高时，SOTR 应在之前进行 MRI 检查后进行个体化筛查。管理不应与普通人群不同。
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