経尿道的前立腺切除術によって発見された前立腺偶発癌(A癌)の臨床的検討

Abstract

Transurethral resection of the prostate was performed on 584 consecutive patients with clinically diagnosed benign prostatic hyperplasia between April 2001 and July 2007. Pathological examinations revealed prostatic cancer in 30 (5.1%) of them. Seventeen patients had stage A1, and 13 stage A2 cancer. Prostatic biopsy was performed on 7 patients. The mean patient age was 69.4 years (range 60-78 years) for stage A1 cancer and 76.6 years (range 62-90 years) for stage A2. The mean serum PSA concentration was 8.9 ng/ml (range 1.18-41.3 ng/ml) for stage A1 cancer and 9.55 ng/ml (range 2.0-23.9 ng/ml) for stage A2. The mean follow-up period was 25.8 months (range 3-82 months) for stage A1 cancer and 27.3 months (range 1-82 months) for stage A2. In stage A1, all patients had a Gleason sum of 6 or less. In stage A2, 11 patients had a Gleason sum of 7 and 2 patients were 8 or more. Total prostatectomy was performed on 2 patients and no therapy on 15 patients with stage A1. Endocrine therapy was given to 1 patient, radiation therapy to 1 patient and no therapy to 11 patients with stage A2. Adjuvant therapy was given to 2 patients with stage A1 and to no one with stage A2. We concluded that PSA monitoring is an option in stage A2 cancer.

過去約6年間に前立腺肥大症と診断して経尿道的前立腺切除術(TURP)施行した584症例中、手術時に発見した偶発前立腺癌30症例について検討した。病期A1が17例(平均年齢69.4歳)、A2が13例(平均年齢76.6歳)で、平均観察期間はA1症例25.8ヵ月、A2症例27.3ヵ月であった。治療はA1例では2例に根治的前立腺全摘除術を施行し、15例は無治療であった。A2例では1例に内分泌療法、1例に内分泌療法併用の放射線療法を施行し、11例は無治療であった。A1の経過観察2例でPSAの上昇を認め、1例には13ヵ月目に内分泌療法を、1例には18ヵ月目に根治的前立腺全摘除術を施行した。A2に限れば、11例の無治療経過観察例は、観察期間は短いが全例無治療PSA経過観察を継続した。TURPで発見される前立腺癌は早期癌がほとんどであり、偶発前立腺癌の無治療経過観察の可能性を示唆すると考えられた。