経尿道的前立腺切除術にて発見された前立腺癌の臨床的検討

Abstract

経尿道的前立腺切除術(TUR-P)でを施行した前立腺肥大症(BPH)463例中, 前立腺癌を認めた15例(66～85歳)を対象に, 偶発前立腺癌について検討した.15例中病理分類では高分化型腺癌13例(87%), 中分化型2例(13%), 病期分類では病期A1が8例(53.3%), A2が7例(46.7%)であった.また, 術前生検の有無・年齢・血清前立腺特異抗原(PSA)値・前立腺容積・PSAD・切除重量についてBPH448例(非癌)と比較検討した結果, 年齢のみに有意差を認めた.TUR-Pの術前説明については手術に伴い偶発前立腺癌が発見されることを, 特に高齢者には十分に説明する必要があると思われた

Transurethral resection of the prostate (TUR-P) was performed on 463 consecutive patients with clinically diagnosed benign prostatic hyperplasia (BPH) between April 1994 and June 2000. Pathological examinations of resected prostatic tissues revealed prostatic cancer in 15 (3.2%) of them. Eight (53.3%) of them were in stage A1, and 7 (46.7%) in stage A2. Between 15 cases with prostatic cancer and those with BPH, clinical features including age, serum prostate specific antigen (PSA) levels, prostatic volume, PSA density (PSAD), and resected prostatic tissue weight were compared. As a result, age was the only parameter related with prostatic cancer with a statistically significant difference. The higher the age, prostate cancer was found more frequently. Postoperatively, radical prostatectomy and antiandrogen therapy were performed in 1 and 9 cases, respectively. The remaining 5 cases are being followed with no treatment for prostatic cancer, and have shown no findings suggesting recurrence. These 15 cases are all living disease-free at present. It seems of importance to explain preoperatively the possible detection of prostatic cancer in association with TUR-P, particularly for elderly patients aged 80 years or older.