PSA 4ng/ml以下前立腺癌の臨床的検討

Abstract

前立腺全摘術を行ったPSA低値前立腺癌15例の臨床病理学的検討を行った.PSA 4ng/ml以下の15例, 4<PSA≦10ng/mlの77例を比較検討した.臨床病期はT1c 8例, T2a 7例であった.直腸診異常は7例であり, 病理学的病期はT2a 8例, T2b 5例, pT3a 2例であった.PSA免疫染色では全例で強陽性を示した.Grey zone cancerにおいて, pT3aが17例, リンパ節転移を2例に認めたが有意差は認めなかった.significant cancerが6例でpT3aが2例であったことから, 前立腺全摘術を含めた根治療法を早期に行うべき症例も存在することを留意する必要性が考えられた

Fifteen out of 140 men (median age 67 years, range 62-75) had a serum prostate-specific antigen (PSA) level of S4 ng/m1 before radical prostatectomy which was performed without preoperative neoadjuvant hormonal therapy between 2001 January and 2004 September. Demographic and clinical data were analyzed. Pathological specimens were evaluated by routine hematoxylin and eosine staining and immunohistochemistry with anti-PSA antibody, for both pathological staging and grading, and for the presence of PSA production. Pathological data were compared between patients with PSA 54 ng/ml and those with 4<PSAS 10 ng/ml. Clinically insignificant cancer was defined as a cancer volume of <0.5 ml and the Gleason score 56. The median PSA level was 3.0 ng/ml (range 1.4-3.9). Thirteen tumors (87%) were pT2. One tumor had a Gleason score of 7 and 14 tumors had a final Gleason score of 56. Nine (60%) tumors were clinically insignificant. Comparison of pathological variables, PSA s4 ng/ml cancer had a significantly lower Gleason score (p=0.0029), and a smaller cancer volume (p = 0.0451) than 4 <PSA 5l0 ng/ml cancer. All tumors were stained strongly for PSA. During a median follow-up of 24 (9-36) months, no patient showed elevated PSA (PSA z0.1 ng/ml). Most prostate cancers in men with a PSA level of 54 ng/ml were pT2, and about half of them were clinically insignificant. All cancers produced PSA