当院における前立腺癌臨床像の変遷 ―受診契機と初診時臨床病期の関連性―

Abstract

前立腺癌と診断された491例を対象にPSA導入前後で受診契機と初診時臨床病期を中心に臨床像に変化が認められるかを検討した.1)受診契機となった症状では排尿障害が前期, 後期共に過半数を占めていたが, 病的症状を自覚せずに健診, ドック, 他科より前立腺疾患精査を依頼され受診した患者が有意に増加していた.2)臨床病期は有意に病期D前立腺癌の割合が減少していたが病期B以下の早期癌の頻度は変わらなかった.3)紹介患者のうちPSAがグレーゾーン以下であった率は14.7%と低いことが, 症状を自覚せずに発見された前立腺癌患者の増加・早期発見につながらない原因の一つであると考えられた

We analyzed the primary symptoms and clinical stage before and after 1988 when the prostate specific antigen (PSA) measurement was introduced in 491 patients with prostate cancer diagnosed in our hospital between 1976 and 1996. Most primary symptoms were related to problems with urination both before and after 1988. However, after PSA measurement became available, the number of patients referred to our hospital by non-urologists increased significantly. In contrast, the frequency of patients with stage D2 disease decreased significantly and the frequency of patients with early prostate cancer (stage A and B) did not increase. Few patients with prostate cancer had PSA levels of 4 to 10 ng/ml. We suggest that general use of PSA for prostate cancer screening by non-urologists does not contribute to the early detection of prostate cancer, most likely because few patients with prostate cancer have low PSA levels.