膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

膀胱移行细胞癌伴发前列腺腺癌的临床与病理

目的探讨膀胱移行细胞癌伴发前列腺腺癌的临床及病理学特点,提高对本病的诊治水平。方法结合文献回顾性分析9例膀胱移行细胞癌伴发前列腺腺癌患者的临床和病理资料。年龄51～75岁,平均68岁。9例均有肉眼血尿,呈间歇性发作;8例有尿频尿急症状;1例有进行性排尿困难;2例有尿痛。直肠指诊：前列腺增生8例,正常1例。2例质硬并可触及结节者行穿刺活检,均为前列腺低分化腺癌,经直肠前列腺超声检查示前列腺包膜下低回声结节。PSA阳性5例,阴性2例,未查2例。膀胱镜检查肿瘤0．5 cm×0．5 cm×0．5 cm～3．0 cm×3．5 cm×5．0 cm大小,病理检查均为膀胱移行细胞癌。结果2例在术前明确诊断为膀胱移行细胞癌伴发前列腺腺癌,余7例均为膀胱前列腺全切术后病理检查证实。1例行膀胱部分切除并前列腺癌根治术,余8例行根治性膀胱前列腺切除。病理结果：9例均为膀胱移行细胞癌,Ⅰ～Ⅱ级1例,Ⅱ级2例,Ⅱ～Ⅲ级3例,Ⅲ级3例;前列腺腺癌,高分化6例,中分化1例,低分化2例。7例随访2～28个月。2例术后1年内死于转移和并发症,5例无瘤存活时间平均17．5个月。结论膀胱移行细胞癌伴发前列腺腺癌是较少见的一种多发性原发癌,包括膀胱移行细胞癌伴发临床期前列腺癌及伴发偶发性前列腺癌2种。膀胱移行细胞癌伴发前列腺癌预后并不差于单纯膀胱癌和前列腺癌。     

膀胱前列腺共存肿瘤的诊断和治疗（附14例报告）

目的：提高对膀胱前列腺共存肿瘤的诊断与治疗水平。方法：结合文献回顾性分析14例膀胱前列腺共存肿瘤患者的临床和病理资料。结果：以膀胱肿瘤首诊11例,术前均经膀胱镜活检病理证实为膀胱移行细胞癌（9例）、鳞癌（2例）,该组有3例行经直肠前列腺穿刺活检,结果2例为前列腺癌,1例为前列腺增生症,该例与余8例行膀胱前列腺切除或TURBT＋TURP后病理证实为前列腺癌。术后随访6～37个月。1例术后23个月死于心梗;1例术后10个月死于全身广泛转移和并发症;1例失访;8例无瘤生存。以前列腺肿瘤首诊3例分别行膀胱部分切除术＋双睾丸切除术、前列腺癌根治术＋TURBT、姑息性输尿管皮肤造瘘术,随访42、16、25个月,2例术后死于多发性转移,1例无瘤生存。结论：膀胱前列腺共存肿瘤是较少见的一种多原发肿瘤,临床上易漏诊。直肠指检、经直肠B超、PsA测定、活检和膀胱镜检的综合应用是目前诊断膀胱前列腺共存肿瘤的主要方法。两者共存并不提示预后不良。     

膀胱移行细胞癌伴发前列腺腺癌五例

为了提高膀胱移行细胞癌伴发前列腺癌的诊断水平，对１９８６年至今收治经病理证实的５例膀胱移行细胞癌伴发前列腺腺癌患者，与膀胱肿瘤浸润前列腺及前列腺癌浸润膀胱两种疾病相比较。术前明确诊断需要注意：（１）前列腺直肠指诊必不可少；（２）术前前列腺穿刺活检可防止漏诊，尤其对可疑前列腺癌者更有必要；（３）膀胱镜检查、活检，前列腺特异性抗原检测具有一定意义。明确诊断对指导治疗及判断预后具有重要意义。     

前列腺癌合并膀胱癌4例分析

目的探讨前列腺癌合并膀胱癌的诊断和治疗。方法总结156例前列腺腺癌患者资料，对其中4例合并膀胱移行细胞癌的患者进行分析。结果4例前列腺腺癌患者均接受B超、尿镜检和膀胱镜检查，发现同时合并膀胱移行细胞癌。其中2例接受经尿道膀胱肿瘤电切术和双侧睾丸切除术；1例接受经尿道膀胱肿瘤电切术和药物去势；1例接受经尿道膀胱肿瘤电切术和耻骨后前列腺根治切除术。术后均接受膀胱灌注治疗。随访12。36个月，除1例膀胱癌复发接受再次电切手术外，其余均无肿瘤复发。结论有血尿、排尿刺激症状和长期吸烟史的前列腺癌患者以及准备行前列腺癌根治手术的患者应进行膀胱镜检查以除外合并膀胱肿瘤。     

原发性前列腺移行细胞癌诊治分析

目的探讨原发性前列腺移行细胞癌的诊断与治疗方法。方法回顾性分析5例原发性前列腺移行细胞癌的临床资料。结果行TURP＋放疗的患者术后12个月死亡。行膀胱造瘘术的患者及合并腺癌行TURP＋双侧睾丸切除加内分泌治疗的忠者分别于术后8个月、15个月死亡。1例行前列腺癌根治术者至今存活已30月，另1例行TURP＋吡柔比星经尿道膀胱灌注化疗存活至今17月。结论本病早期诊断困难，确诊有赖于经直肠B超引导下前列腺穿刺活检或通过术后标本的病理检查，早期行前列腺癌根治术是较为有效的治疗方法，本病预后欠佳。     

膀胱原发性印戒细胞癌伴发前列腺腺癌1例报告及文献复习

目的:探讨膀胱原发性印戒细胞癌(primary signet ring cell carcinoma of the bladder.PSRCC)伴前列腺癌的临床特征及诊治方法。方法:总结1例膀胱PSRCC伴前列腺癌患者的资料,检索Pubmed、CBM数据库相关文献并复习。结果:膀胱镜检病理示膀胱印戒细胞癌。血PS A:12.73 ng/ml,FPSA:0.737 ng/ml,FPSA/PSA:0.06。前列腺穿刺活检示前列腺腺癌,Gleason评分3+3。行经尿道膀胱肿瘤切除术(TURBT)术和最大限度雄激素阻断治疗,术后1 6个月膀胱癌复发。结论:膀胱PSRCC临床少见,浸润性强,进展快,诊断主要依靠病理和免疫组织化学检查,对于膀胱PSRCC伴发前列腺癌首选根治性膀胱前列腺切除术治疗,预后差。     

吉西他滨联合顺铂治疗膀胱癌阴茎转移一例

<正>患者,男,79岁。因膀胱癌全切术后2年,阴茎疼痛2个月于2014年10月8日人院。患者2年前诊断为膀胱癌,于2012年3月5日静脉全麻下行根治性膀胱切除+双侧输尿管皮肤造口术,病理诊断膀胱移行细胞癌Ⅱ级,癌瘤灶状浸润肌层,前列腺、精囊未见癌。2月前出现阴茎持续勃起,伴剧烈疼痛,有尿道分     

前列腺小细胞癌二例报告并文献复习

目的探讨前列腺小细胞癌的临床、病理特征及治疗方法。方法总结2例前列腺小细胞癌患者的临床资料并进行文献复习。例1,50岁,因排尿困难伴会阴部疼痛3个月入院。直肠指检前列腺Ⅲ度(5．0 cm×6．0 cm)增生,质硬,表面欠光滑。血清PSA 0．31 ng／ml,fPSA 0．09ng／ml。B超示低回声块,CT示前列腺密度不均。经直肠穿刺活检示前列腺癌,行前列腺癌根治术。例2,82岁,因排尿困难伴间歇性血尿4个月入院。直肠指检前列腺Ⅱ度(4．0 cm×5．0 cm)增生,质硬伴多发性结节,表面欠光滑。血清PSA 2．61 ng／ml,fPSA 0．05ng／ml。B超示低回声块,CT示前列腺密度不均,精囊及膀胱颈部受侵犯。经直肠穿刺活检示前列腺小细胞癌,行双睾切除术加TURP。结果2例术后病理均诊断为前列腺小细胞癌。肿瘤呈弥漫性片巢状结构,伴大片凝固性坏死,核小、燕麦状或圆形、染色深、核仁不明显、胞质少,类似肺小细胞癌。精囊及膀胱颈部均有肿瘤细胞浸润。免疫组化染色检查:LCA、L-26、34βE12(-),PSA、AE1／AE3、AR(+),CA、S-100(±)。例1术后1个月死于广泛肺转移,例2术后3个月发现后腹膜转移,仍在随访中。结论前列腺小细胞癌少见,确诊依靠临床及病理表现。对早期前列腺小细胞癌,根治性前列腺癌切除术加激素及化疗是可行的,晚期患者则无较满意的治疗方法,且预后差。     

前列腺移行细胞癌(附2例报告)

目的；提高前列腺移行细胞癌的诊治水平。方法：回顾分析2例前列腺移行细胞癌患者临床资料，结合文献复习讨论。结果：1例行前列腺癌根治术，术后予吡柔比星膀胱灌注化疗，现仍在随访中，另1例行经尿道前列腺切除术加经尿道电气化术，术后半年死亡。结论：本病多以肉眼血尿就诊。确诊主要依赖前列腺穿刺活检及术后病理检查。治疗以手术加膀胱灌注化疗为主，预后较其他前列腺癌差。     

前列腺肉瘤的诊治分析（附8例报告）

目的：探讨前列腺肉瘤的诊断、治疗及预后。方法：回顾性分析1992年3月~2010年1月收治的8例前列腺肉瘤患者的临床资料,就其诊治及预后进行研讨。结果：8例患者中,横纹肌肉瘤2例、平滑肌肉瘤2例及粒细胞肉瘤、恶性间叶瘤、叶状囊肉瘤各1例,1例穿刺为问叶源性恶性肿瘤,未进一步分类。4例行根治性前列腺切除术,3例术后未行辅助治疗,分别于术后16、10、8个月死于远处转移,另1例失访;1例行根治性膀胱切除术,术后辅以规律化疗,无瘤存活至今16个月;3例未行手术治疗,依靠穿刺确诊,1例行辅助化疗后存活4个月,死于远处转移,其余2例未行辅助治疗,分别于确诊后4、5个月死于全身转移。结论：前列腺肉瘤首发症状大多为进行性排尿困难,PSA及DRE检查不能确诊前列腺肉瘤,术前需依靠磁共振成像、经直肠超声及前列腺穿刺活检共同确诊,免疫组化染色有助于其分类。该病预后差,治疗以根治性前列腺切除术为主,术后联合放、化疗等辅助治疗可提高患者生存率。     

成人非腺癌前列腺恶性肿瘤13例报告

目的:探讨成人非腺癌前列腺恶性肿瘤的临床特征。方法:报告经治的13例成人非腺癌前列腺恶性肿瘤患者的临床资料。经直肠指检、B超及CT检查诊断,经病理检查确诊。结果:10例15个月内因肿瘤全身转移死亡,3例经以根治术式为主的综合治疗后存活超过13个月。结论:直肠指检、B超及CT检查对成人非腺癌前列腺恶性肿瘤的诊断有重要意义,确诊须依靠组织病理学检查;目前的有效治疗方法是以根治术式为主的综合治疗。其预后差。     

Dedifferentiation of prostate cancer grade with time in men followed expectantly for stage T1c disease

PURPOSE: We assess whether the Gleason grade changes in men followed expectantly with clinical stage T1c prostate cancer. MATERIAL AND METHODS: We studied 70 men with stage T1c prostate cancer who underwent watchful waiting with repeat needle biopsy sampling to assess for progression. After the initial cancer diagnosis all men had at least 1 other biopsy demonstrating cancer. RESULTS: Of 70 cases 9 (12.9%) showed a significant change in grade from Gleason scores 6 or less to 7 or greater. The average followup of those patients without a change in grade was 22 months and greater than those with a change in grade. There was no difference between the groups with and without changes in grade in regard to initial prostate specific antigen (PSA), percent-free PSA, or PSA density or velocity. Of 9 cases there were 5 (56%) and 8 (89%) with grade change that occurred at 12 and 15 months or less after initial biopsy, respectively. In contrast, only 1 of 24 (4%) patients in whom last re-biopsy was performed 24 months or greater after the initial cancer diagnosis had a change in grade. Of the 21 men who underwent radical prostatectomy 5 (24%) had worsening of grade on the radical prostatectomy specimen compared to biopsy, with a mean interval of 18 months between the initial cancer diagnosis and prostatectomy. This prevalence of grade change is less than in our population that underwent prostatectomy within 1 to 3 months after biopsy. CONCLUSIONS: Because most grade changes occurred relatively soon after biopsy, it implies that tumor grade did not evolve but rather the higher grade component was not initially sampled. During a 1 1/2 to 2-year period after biopsy there is no evidence that prostate cancer grade worsens significantly. Men with prostate cancer need not feel concerned about waiting several months before undergoing surgery after biopsy. Furthermore, men undergoing watchful waiting can be reassured that there is little evidence that prostate cancer grade worsens during the short term.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.     

腹膜外径路腹腔镜前列腺癌根治术(附12例报告)

目的探讨腹膜外途径腹腔镜前列腺癌根治术的临床效果。方法回顾性分析总结2009年5月至2011年7月经腹膜外径路进行腹腔镜前列腺癌根治术患者12例,年龄60～75岁,平均年龄68岁。血清前列腺特异性抗原(prostate specific antigen,PSA)为0.7～23.6ng/ml。TNM分期T1N0M08例,T2N0M03例,T3aN0M01例。所有患者均于术前行前列腺穿刺活组织检查,证实为前列腺癌。结果 12例患者均顺利完成手术,手术时间为130～360min,平均270min;术中出血量为150～900ml,平均390ml,1例患者术中输血。术后病理检查结果显示肿瘤切缘为阳性的2例患者术后加用全雄激素阻断治疗3个月。术后留置尿管时间14～22d,平均18.6d,无直肠损失病例,3例术后出现轻度尿失禁的患者经提肛训练等辅助治疗3个月后好转,能自主排尿。术后3个月时PSA为0.02～0.10ng/ml,术后随访8例,随访时间为3～24个月,未发现肿瘤局部复发和远处转移。结论腹膜外径路腹腔镜前列腺癌根治术视野清晰、创伤小、恢复快,是一种安全、有效的治疗方法,值得临床推广。     

Salvage radical prostatectomy for radiorecurrent prostate cancer: morbidity revisited

PURPOSE: With the advent of prostate specific antigen (PSA) testing and transrectal ultrasound guided prostate biopsy there has been stage migration in the diagnosis of prostate cancer, so that more younger men are being diagnosed with organ confined prostate cancer. Many patients elect radiation therapy, while some have recurrent or new prostate cancer with absent systemic disease and life expectancy greater than 10 years. We present our experience with salvage radical prostatectomy in these cases. MATERIALS AND METHODS: Between 1995 and 2000, 6 men treated with curative intent with radiotherapy for prostate cancer were subsequently treated with salvage surgery for clinically localized prostate cancer. All men had biopsy proved recurrent or persistent prostate cancer, increasing serum PSA, no evidence of systemic disease at surgery and life expectancy greater than 10 years. We assessed the morbidity associated with this procedure and compared results to those in the contemporary literature. RESULTS: Six patients underwent salvage radical prostatectomy. Initial pre-radiation PSA was 4.5 to 15.7 ng./ml. Pre-radiation disease was clinical stage T1c in 5 cases and B2 in 1. The interval from radiotherapy to repeat biopsy was 12 to 48 months. A mean of 6.3 months after local recurrence was detected and before salvage radical prostatectomy was performed 4 patients underwent androgen deprivation therapy. Mean operative time was 195 minutes, intraoperative blood loss was 680 cc, and hospital stay and catheterization time were 3.2 and 13.8 days, respectively. There were no rectal injuries. All 6 patients are impotent, 5 are continent and 1 has mild stress incontinence. There was biochemical failure in 1 case 36 months after salvage radical prostatectomy and no evidence of recurrence in the remaining 5 at a mean followup of 27 months. CONCLUSIONS: Salvage radical prostatectomy is a technically challenging procedure. In the past it was associated with a high incidence of rectal injury, urinary incontinence and anastomotic stricture. The results of our relatively small series are encouraging and concur with those of recent studies that the morbidity of salvage radical prostatectomy is lower than previously reported. We believe that salvage radical prostatectomy may be considered a reasonable treatment option in appropriate patients with radiorecurrent prostate cancer.     

经腹膜外途径腹腔镜前列腺癌根治术23例观察

目的探讨经腹膜外途径腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)治疗局限性前列腺癌的手术方法和临床疗效。方法回顾性分析23例前列腺癌患者行经腹膜外途径腹腔镜前列腺癌根治术的临床资料。23例患者病理诊断均为前列腺癌,TNM分期T1N0M0 9例,T2N0M0 14例,Gleason评分均≤7分。结果 23例手术均获得成功,无中转开放手术。手术时间105³00 min,平均150 min;术中出血量120300 min,平均150 min;术中出血量120⁸00 mL,平均240 mL。术后留置尿管时间16800 mL,平均240 mL。术后留置尿管时间16²2 d,平均18 d。3例出现轻度尿失禁,经提肛等辅助治疗,3个月后无真性尿失禁发生。术后病理报告示标本切缘阳性1例,术后行全激素阻断治疗3个月。术后前列腺特异性抗原(prostate specific antigen,P S A)均<4.0 ng/mL。1例因其他原因死亡。术后随访322 d,平均18 d。3例出现轻度尿失禁,经提肛等辅助治疗,3个月后无真性尿失禁发生。术后病理报告示标本切缘阳性1例,术后行全激素阻断治疗3个月。术后前列腺特异性抗原(prostate specific antigen,P S A)均<4.0 ng/mL。1例因其他原因死亡。术后随访3¹2个月,无生化复发。结论经腹膜外腹腔镜前列腺癌根治术具有创伤小,出血少,恢复快,并发症少等优点,是一种安全可行的手术方式,值得临床推广。     

Salvage surgery for bulky local recurrence of prostate cancer following radical prostatectomy

PURPOSE: We report our experience with salvage radical surgery as palliative treatment in patients with bulky recurrence of prostate cancer following radical prostatectomy (RP). MATERIALS AND METHODS: From files at the department of urology we identified 5 patients who had biopsy confirmed, bulky recurrence of prostate cancer after initial RP and subsequent salvage radiation therapy (4), prior to presentation at our cancer center. Positive surgical margins were present in all 5 patients. All received androgen ablation and 4 also received systemic chemotherapy. Due to persistent bulky tumors in the 5 patients and debilitating unrelenting symptoms, including refractory hematuria, obstructive uropathy and pelvic pain in 4, salvage radical surgery was performed. Total pelvic exenteration was done in 4 patients and wide tumor resection with continent urinary diversion was done in 1. RESULTS: Four patients were permanently relieved of local symptoms following surgery and another had entero-urethral fistula formation. Revision of a continent urinary diversion was necessary in another patient who was otherwise free of cancer and of local pelvic symptoms. Long-term symptom-free survival was achieved in 2 patients following surgery at 26 and 56 months, respectively. One patient died of metastatic disease 3.5 months after surgery but he had been rendered free of local symptoms by surgery. The other 2 patients are currently free of local symptoms 5 and 7 months following surgery, respectively. Wound infection, delirium and prolonged ileus occurred in 1 patient each. Otherwise surgery was well tolerated. CONCLUSIONS: Salvage radical surgery is feasible and it provides effective palliation in patients with bulky local recurrence following RP.     

Reasonable Delay of Surgical Treatment in Men with Localized Prostate Cancer - Impact on Prognosis?

PURPOSE: In many centers patients with clinically localized prostate cancer might be confronted with a delay in therapy due to not immediately available treatment capacity at that specific center. Furthermore, a growing amount of patients want to have a second or third opinion before they finally decide what therapeutic option to choose. We investigated whether a reasonable delay from diagnosis to definitive treatment impact recurrence free survival rates in men undergoing radical prostatectomy (RP) for localized prostate cancer. MATERIAL AND METHODS: Preoperative data of 795 men treated for localized prostate cancer by RP between 1/1992 and 6/2000 were evaluated including pretreatment PSA, clinical stage and biopsy Gleason score. In addition, time from biopsy to the date of RP was obtained and investigated as a potential prognostic factor. The influence of the time gap between biopsy and surgery was statistically evaluated by univariate Cox regression analyses and Kaplan-Meier analyses; a multivariate Cox Modell was performed including all preoperative parameters. Relapse following RP was defined as a postoperative PSA level >0.1 ng/ml. RESULTS: Mean followup of the patients was 33 months (1-116 months). Twenty-five percent of the patients failed during that time period. Mean time gap between diagnosis and treatment was 62 days (median 54 days) ranging from 5 to 518 days. Univariate Cox regression analysis showed no significant correlation (p=0.062) of waiting time with recurrence rate. Multivariate Cox regression documented a highly significant association of PSA (p<0.001), clinical stage (p=0.001) and biopsy Gleason grade (p<0.001) but not not for time to treatment (p=0.841). In patients with high-grade cancer again no significant impact of treatment delay was found. CONCLUSION: Treatment delay in the investigated time span of a few months did not adversely affect recurrence free survival rates. Patients can be reassured that they can evaluate treatment options without compromising efficacy due to a delay in treatment.