前列腺癌诊断方法的探讨（附210例报告）

发布时间：2018-03-31 01:37

本文选题：前列腺癌　切入点：tPSA　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：前列腺癌为泌尿外科的常见恶性肿瘤之一。近年来相关研究资料显示，我国前列腺癌的发病率呈上升趋势。本文通过回顾性临床研究旨在比较分析前列腺癌各种检查方法的优缺点以改进其诊断方法。方法：搜集我院2009年到2013年之间经术后病理确定为前列腺癌患者210例，整理分析其临床资料，应用AJCC的TNM分期系统分期，比较各诊断方法，，如直肠指诊、血清PSA检验、前列腺穿刺活检等，统计方法各变量频数以百分率表示，率的比较、计数资料的比较分析采用卡方检验，P0.05具有统计学意义。结果 1.210例前列腺癌患者，年龄52-86岁，平均年龄为72岁。其中：小于60岁组15列（7.1%），60岁到80岁之间143例（68.1%），大于80岁52例（24.8%）。 2.有临床症状197例（93.8%），症状包括血尿患者95例（45.2%）、下尿路症状185例（88.1%）（包括排尿困难、尿频尿急尿痛及尿潴留等），无临床症状因体检或前列腺增生术后病理偶然发现13例（6.2%）。分期T1-28例（3.8%），T3-4202例（96.2%）。全身骨扫描示转移89例（67.4%），无转移43例（32.6%）。 3.血清tPSA值4ng/ml190例（90.5%）；4ng/ml20例（9.5%）；4-10ng/ml13例（6.2%）；10ng/ml177例（84.3%；，f/t0.16为30例（14.3%），0.16为180例（85.7%）。210例患者临床分期及相应血清PSA值，分别为：T1-28例，PSA（14.7±2.0）ng/ml；T3103例，PSA（62.4±5.3）ng/ml；T499例，PSA（89.4±10.6）；相关回归分析显示：PSA与临床分期显著相关（P0.001）。 4.210例中行全身骨扫描132例，发现骨转移89例（67.4%），无转移43例（32.6%），取PSA值20ng/ml为临界值预测其前列腺癌骨转移的灵敏度、特异性和准确性分别为87.6%（78/89）、67.4%（29/43）和81.1%（107/132）。 5.210例患者均行DRE检查，前列腺癌DRE特征为触及结节或质地坚硬，本组DRE提示前列腺癌113例（53.4%)。 6.210例中行6针法穿刺活检31例，其中30例病理结果为阳性，穿刺阳性检出率达96.8%。 7.本组210前列腺癌病例中行CT检查138例，其中CT结果诊断前列腺癌49例，诊断正确率35.5%，其中，不同临床分期CT诊断正确率分别为：T1-2期1/8例（12.5%），T3-4期48/202例（23.8%）；行MRI41例，MRI结果诊断前列腺癌32例，诊断正确率78.0%；其中不同临床分期MRI诊断正确率分别为：T1-2期3/8例（37.5%），T3-4期38/202例（14.4%）。结论 1.60-80岁为前列腺癌的高发年龄，男性从50岁开始应每年常规行PSA检测及DRE检查。血清PSA小于10ng/ml时，应结合患者年龄、f/t比值密切随诊及进一步检查。 2.PSA值在预测前列腺癌骨转移上具有临床意义，PSA大于20ng/ml时，骨转移可能性极大。DRE与PSA检测联合应用能提高前列腺癌的阳性诊出率。 3.经直肠前列腺穿刺活检可以确定诊断，PSA正常但DRE为阳性者，应尽早行穿刺活检。 4.CT及MRI对前列腺癌诊断阳性率不够，但在分期诊断中有重要意义。 5.部分前列腺癌PSA可能正常。
[Abstract]:Objective: prostate cancer is one of the most common malignant tumors in urology. The incidence of prostate cancer in China is on the rise. The purpose of this paper is to compare and analyze the advantages and disadvantages of various examination methods of prostate cancer in order to improve their diagnostic methods. Methods: 210 cases of prostate cancer confirmed by postoperative pathology between 2009 and 2013 were collected and analyzed. The clinical data were analyzed and the TNM staging system of AJCC was used to compare the diagnosis methods, such as rectal digital diagnosis and serum PSA test. Prostate biopsy and so on, the statistical method of the frequency of the variables expressed as a percentage, the rate of comparison, counting data of comparative analysis using chi-square test (P0.05) has statistical significance. Results. 1.210 patients with prostate cancer, 52 to 86 years old, with an average age of 72 years. 2. There were 197 patients with clinical symptoms, including 95 patients with hematuria, 95 patients with hematuria, 185 patients with lower urinary tract symptoms, including dysuria. No clinical symptoms were found in 13 cases of prostatic hyperplasia by chance because of physical examination or pathology after prostatic hyperplasia. Staging T _ (1-28) cases with T _ (3) and T _ (3) ~ (4202) cases with T3-4202 cases with 96.22.The whole body bone scan showed metastasis in 89 cases (67.4%), and no metastasis in 43 cases (32.6%). 3. The serum tPSA value of 4ng/ml190 was 90.5 ng / ml = 9.5ngml = 9.5ngml = 9.5ngml / ml 13 cases respectively and 62.4 卤5.3ngml / ml 13 cases and 84.3ng/ ml / 177ng / ml 13 cases respectively. The correlation regression analysis showed that there was a significant correlation between the clinical stage and the corresponding serum PSA value of 180 patients (85.77.210 cases), and the correlation regression analysis showed that there was a significant correlation between PSA and clinical staging in 89.4 卤610.210 cases of PSA-positive patients. The regression analysis showed that there was a significant correlation between PSA and clinical stage in 89.4 卤610.10% cases of PSAA. The regression analysis showed that there was a significant correlation between PSA and clinical stages. The correlation regression analysis showed that there was a significant correlation between PSA and clinical stages. Of the 4.210 cases, bone metastases were found in 89 cases (67.4%) and no metastasis in 43 cases (32.6%). The sensitivity of PSA 20ng/ml was taken as the critical value to predict the bone metastasis of prostate cancer. The specificity and accuracy were 87.6 / 89 / 67.4 / 29 / 43 and 81.1 / 137 / 132respectively. DRE examination was performed in all 5.210 patients. The DRE of prostate cancer was characterized by touching nodule or hard texture. DRE suggested that there were 53.4% prostate cancer cases in this group. Among the 6.210 cases, 31 cases were performed 6 needle biopsy, 30 of them were positive in pathology, the positive rate of puncture was 96.8%. In this group of 210 cases of prostate cancer, 138 cases were examined by CT, 49 cases of which were diagnosed by CT, the correct rate of diagnosis was 35. 5%. The correct rate of CT diagnosis in different clinical stages was: 1 / 1 / 1 / 8 of stage 1: 1 / 1, 12. 5% and 48 / 202 of stage T3-4, respectively; 32 cases of prostate cancer were diagnosed by MRI41, the diagnostic accuracy rate was 78.0, and the correct rate of diagnosis of MRI in different clinical stages was T: 1-2 3 / 8 cases with 37.5% T3-4 stage and 38 / 202 cases with T 3 / 4 stage and 14. 4% respectively. Conclusion. 1.60-80 years old is the high risk age of prostate cancer, male should routine PSA test and DRE examination every year from 50 years old. When the serum PSA is less than 10ng/ml, it should be closely followed up and further checked in combination with the patient's age / f / t ratio. The value of 2.PSA has clinical significance in predicting bone metastasis of prostate cancer. When the probability of bone metastasis is greater than that of 20ng/ml, the combination of Dre and PSA can improve the positive diagnosis rate of prostate cancer. 3. Transrectal prostate biopsy can confirm the diagnosis of normal PSA but positive DRE, should be performed as early as possible. The positive rate of 4.CT and MRI in the diagnosis of prostate cancer is not enough, but it is important in staging diagnosis. 5. Partial prostate cancer PSA may be normal.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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