Bruce A W, O'Cleireachain F, Morales A, Awad S A
J Urol. 1977 Mar;117(3):319-22. doi: 10.1016/s0022-5347(17)58446-3.
To stage accurately the extent of the disease comprehensive investigations were done on 75 patients with histologically documented carcinoma of the prostate. Estimation of bone marrow acid phosphatase appears to be the most sensitive test to detect blood-borne metastases. Serum acid phosphatase appears to be of little value in the detection of early blood spread and may have a role only in monitoring the effect of treatment on advanced disease. Bone scanning with technetium compounds has the disadvantage of non-specificity but has far greater sensitivity than a skeletal survey. Bone marrow cytology was not rewarding in the detection of early metastatic disease. Pedal lymphangiography is a highly inaccurate method to detect lymphatic spread of carcinoma of the prostate and pelvic lymphadenectomy, when indicated, remains the only truly adequate method to assess lymph node involvement. There was a 37 per cent incidence of metastatic lymph node pathology in 30 patients undergoing this procedure before either radical prostatectomy or deep x-ray therapy. A close correlation was found between stage and grade of disease and incidence of nodal pathology. There was some correlation between degree of nodal involvement and evidence of blood spread as detected by elevated bone marrow acid phosphatase levels. The significance of this finding remains unclear.
为了准确分期疾病范围，对75例经组织学证实为前列腺癌的患者进行了全面检查。骨髓酸性磷酸酶测定似乎是检测血行转移最敏感的检查。血清酸性磷酸酶在检测早期血行播散方面似乎价值不大，可能仅在监测晚期疾病的治疗效果方面有作用。锝化合物骨扫描有非特异性的缺点，但比骨骼X线检查敏感性高得多。骨髓细胞学检查在检测早期转移性疾病方面效果不佳。足部淋巴管造影是检测前列腺癌淋巴转移的一种极不准确的方法，盆腔淋巴结切除术在有指征时仍然是评估淋巴结受累情况的唯一真正充分的方法。在30例在根治性前列腺切除术或深部X线治疗前行此手术的患者中，转移性淋巴结病理发生率为37%。发现疾病分期和分级与淋巴结病理发生率密切相关。淋巴结受累程度与骨髓酸性磷酸酶水平升高所检测到的血行播散证据之间存在一定相关性。这一发现的意义尚不清楚。
