Johnson T L
National College of Chiropractic Clinic, Chicago, IL.
J Manipulative Physiol Ther. 1994 Feb;17(2):107-12.
To present a case in which the initial diagnosis of spinal metastasis secondary to prostate cancer was established from findings of the digital rectal examination (DRE) and serum prostate-specific antigen (PSA) analysis.
A 79-yr-old black male was seen after suffering from low back pain for 1 month. Urinary frequency and nocturia were associated symptoms. Abnormal findings on the DRE and serum PSA determination suggested a preliminary diagnosis of spinal metastases secondary to prostate cancer. Subsequent referral for biopsy and bone scan yielded the final diagnosis of prostate adenocarcinoma with spinal metastasis. Radiographs of the lumbosacral spinal region were inconclusive and results of routine laboratory tests (CBC, ESR, U/A) were within normal limits.
The patient was referred for medical palliation of his condition. A bilateral orchiectomy was performed along with oral antiandrogen administration. At a consultation 8 months postoperatively, he reported to be free of pain.
At least 40% of newly diagnosed cases of prostate cancer can be expected to have metastasized at the time of initial discovery. Routine use of DRE and serum PSA in patients complaining of low back pain who are at high risk for prostate cancer is recommended. However, mass screening with DRE or PSA in asymptomatic males is not recommended. There are no prospective studies showing evidence that mass screening for prostate cancer will reduce the mortality or morbidity rates from the disease.
介绍一例通过直肠指检（DRE）和血清前列腺特异性抗原（PSA）分析结果确诊为前列腺癌继发脊柱转移的病例。
一名79岁黑人男性，因下背痛1个月前来就诊。尿频和夜尿是相关症状。DRE检查及血清PSA测定的异常结果提示初步诊断为前列腺癌继发脊柱转移。随后转诊进行活检和骨扫描，最终诊断为前列腺腺癌伴脊柱转移。腰骶部脊柱区域的X线片结果不明确，常规实验室检查（血常规、血沉、尿常规）结果均在正常范围内。
该患者转诊接受病情的医学姑息治疗。实施了双侧睾丸切除术并给予口服抗雄激素药物。术后8个月的一次会诊中，他报告已无疼痛。
预计至少40%新诊断的前列腺癌病例在初次发现时已有转移。建议对有下背痛且前列腺癌高危的患者常规使用DRE和血清PSA检查。然而，不建议对无症状男性进行DRE或PSA大规模筛查。尚无前瞻性研究表明前列腺癌大规模筛查能降低该病的死亡率或发病率。
