Stamey T A, Dietrick D D, Issa M M
Department of Urology, Stanford University School of Medicine, California.
J Urol. 1993 Mar;149(3):510-5. doi: 10.1016/s0022-5347(17)36131-1.
We present 3 of 25 patients with massive, occult transition zone cancers 7 to 86 cc in volume. Despite serum prostate specific antigen (PSA) levels of 150 to 456 ng./ml. (Yang polyclonal assay), all 3 were organ confined at radical prostatectomy and have undetectable serum PSA levels by an ultrasensitive assay at 300 to 650 days postoperatively. This clinical syndrome includes a highly elevated PSA level, benign prostatic hyperplasia on digital rectal examination, a nondiagnostic transrectal ultrasound and frequently negative transrectal or perineal needle biopsies. Clinical recognition of this syndrome plus systematic biopsies of the transition zone are the keys to diagnosis and potential cure of these patients. These cases may explain the 10% rate of men who present with metastatic prostate cancer and a normal rectal examination, much of the discrepancy between focal cancer on biopsy and large cancers in radical prostatectomy specimens, and why some men have an extraordinarily high serum PSA level and organ-confined cancer at prostatectomy.
我们报告了25例体积为7至86立方厘米的隐匿性移行区大癌患者中的3例。尽管血清前列腺特异性抗原（PSA）水平为150至456纳克/毫升（杨的多克隆检测法），但这3例患者在根治性前列腺切除术中均局限于器官内，且术后300至650天通过超敏检测法检测不到血清PSA水平。这种临床综合征包括PSA水平高度升高、直肠指检显示良性前列腺增生、经直肠超声检查无诊断意义以及经直肠或会阴穿刺活检经常为阴性。对该综合征的临床认识以及对移行区进行系统活检是诊断和治愈这些患者的关键。这些病例可能解释了10%出现转移性前列腺癌且直肠检查正常的男性比例、活检中局灶性癌与根治性前列腺切除标本中较大癌之间的许多差异，以及为什么一些男性血清PSA水平极高且在前列腺切除术中为器官局限性癌。
