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目的探讨前列腺泡沫状腺癌的临床病理特征、诊断、治疗及预后。方法回顾性分析2004年5月至2014年5月上海交通大学医学院附属仁济医院收治的15例前列腺泡沫状腺癌患者的临床资料,并结合相关文献进行讨论。结果患者年龄49~85岁,平均(69.53±8.97)岁,主要症状为进行性排尿困难,Gleason评分:6分1例,7分6例,8分4例,9分4例。9例行双侧睾丸切除术,6例行前列腺癌根治术。睾丸切除术患者术前PSA 27.1~153ng/mL,平均(79.37±57.52)ng/mL;术后1月PSA0.13~2.86ng/mL,平均(0.83±1.01)ng/mL;Nadir PSA 0.002~1.33ng/mL,平均(0.37±0.45)ng/mL;达到Nadir PSA时间8~23月,平均(17.23±5.28)月;7例经12~42月出现去势抵抗,平均为(26.43±9.55)月;发生转移5例;9例患者中2例失访,3例死于晚期前列腺癌,4例存活;随访时间平均(60.86±22.11)月。前列腺癌根治术患者术前PSA 11.47~128ng/mL,平均(43.40±43.13)ng/mL;术后1月PSA 0.072~0.36ng/mL,平均(0.17±0.11)ng/mL;Nadir PSA 0.008~0.22ng/mL,平均(0.11±0.07)ng/mL;达到Nadir PSA时间24~42月,平均(33.17±7.28)月;5例经12~60个月出现生化复发,平均为(35.20±17.43)月,复发后1例予康士得及诺雷德治疗,4例予氟他胺治疗,目前生存状况尚可;发生转移3例;6例患者均存活;随访时间平均(53.00±28.04)月。结论前列腺泡沫状腺癌是一种侵袭性强、预后较差的特殊组织学亚型的高级别腺癌。
Objective To investigate the clinicopathological features, diagnosis, treatment and prognosis of prostate foamy adenocarcinoma. Methods The clinical data of 15 patients with prostate-derived foamy adenocarcinoma admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2004 to May 2014 were retrospectively analyzed and discussed with relevant literatures. Results The age ranged from 49 to 85 years (mean, 69.53 ± 8.97). The main symptoms were progressive dysuria. The Gleason score was 6 in 1, 7 in 6, 8 in 4, and 9 in 4. 9 cases of bilateral orchidectomy, 6 cases of radical prostatectomy. The preoperative PSA was 27.1 ~ 153 ng / mL for orchidectomy with an average of (79.37 ± 57.52) ng / mL and PSA 0.13 ~ 2.86 ng / mL at 1 month after operation (mean, 0.83 ± 1.01 ng / mL, (0.37 ± 0.45) ng / mL for the Nadir PSA group. The time to Nadir PSA was 8-23 months (mean, 17.23 ± 5.28 months). The castration resistance was found in 7 cases (12.42 ± 9.55) ) Months; 5 cases had metastasis; 2 of 9 cases were lost to follow-up, 3 died of advanced prostate cancer and 4 survived. The average follow-up time was 60.86 ± 22.11 months. The PSA of preoperative prostatectomy patients was 11.47 ~ 128ng / mL, with an average of (43.40 ± 43.13) ng / mL and PSA of 0.72 ~ 0.36ng / mL at 1 month postoperatively, with an average of 0.17 ± 0.11 ng / mL and Nadir PSA of 0.008 ~ 0.22 ng / mL, mean (0.11 ± 0.07) ng / mL; Nadir PSA reached 24-42 months with an average of (33.17 ± 7.28) months; biochemical relapse occurred in 12 cases ) Month after recurrence, one case was given Conrad and Norred treatment after recurrence, and 4 cases were treated with flutamide. The survival status was acceptable at present; 3 cases had metastasis; all 6 cases survived; mean follow-up time was 53.00 ± 28.04 months . Conclusions Prostate foamy adenocarcinoma is a high-grade adenocarcinoma of special histological subtypes with strong aggressiveness and poor prognosis.