根治的前立腺全摘術を行ったPSA 20ng/ml以上の前立腺癌症例の検討  [in Japanese] CLINICOPATHOLOGICAL STUDY OF PROSTATE CANCER PATIENTS WHO HAD A SERUM PSA LEVEL OF MORE THAN 20 NG/ML AND WERE TREATED BY A RADICAL PROSTATECTOMY  [in Japanese]

(目的)PSA 20ng/ml以上で臨床的に転移を認めない前立腺癌症例の臨床的・組織学的な特徴,予後について検討し,前立腺全摘術による治療が意義あるものか検討した.(対象と方法)根治的前立腺全損術を施行した前立腺癌症例のうちPSA 20ng/ml以上であった21症例について,術前臨床所見と全摘標本の病理学的所見を検討した.(結果)術前PSA値は21〜65ng/ml,中央値27ng/mlであった.主腫瘍が70%以上存在する部位で近縁領域(PZ)癌と移行領域(TZ)癌に分類しそれぞれ10例ずつであった.PZ癌群では組織学的リンパ節転移が2例,精嚢浸潤が8例,被膜外浸潤が全例,外科的切除縁陽性が7例であった.TZ癌群ではリンパ節転移,精嚢浸潤は1例もなく,被膜外浸潤が5例,外科的切除縁陽性が6例であった.術前検査ではPZ癌群は全例直腸診. TRUS陽性であったが,TZ癌群では直腸診およびTRUS所見は乏しかった.年齢,PSA値,癌体積,グリソンスコアには差はなかった.PSA再発はPZ癌群では9涯TZ癌群では2例であった.(結語)PSA 20ng/ml以上の症例ではPZ癌であれば手術療法のみでの根治は難しいと考えられたが,TZ癌であれば比較的良好な成績が得られた.直腸診・TRUS所見が乏しければTZ癌を積極的に疑うことが重要であり,また根治的前立腺全摘術も根治的治療の一つであると考えられた.

(Purpose) In order to assess the validity of radical prostatectomy for the prostate cancer with PSA greater than 20 ng/ml, we reviewed the clinicopathological characteristics and prognoses of radical prostatectomy cases with PSA greater than 20 ng/ml. (Material and methods) Twenty-one radical prostatectomy cases who had a serum PSA level greater than 20 ng/ml were reviewed regarding their clinicopathological characteristics. Stepsectioned specimens were used for pathological evaluation. (Result) The serum PSA level ranged from 21 to 65 ng/ml (median: 27 ng/ml). As for the clinical stage, there were 8 Tic cases, 5 T2b cases, 5 T2c cases, and 3 T3a cases (2001. TNM classification) . According to the tumor location, 10 cases were diagnosed as peripheral zone (PZ) cancer, and 10 cases were diagnosed as transition zone (TZ) cancer. One case had several small cancer foci both in PZ area and TZ area. In 10 PZ cancer cases, 2 cases had lymph node metastasis, and 8 had seminal vesicle invasion. All of 10 PZ cancer cases showed extraprostatic extension, and 7 showed positive surgical margin. On the other hands in 10 TZ cancer cases, no cases had lymph node metastasis and seminal vesicle invasion. Five TZ cancer cases showed extraprostatic extension, and 6 showed positive surgical margin. The findings of digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were positive in all PZ cancer cases, but these findings were unclear in TZ cancer cases. In addition, no significant difference were observed between the PZ cancer cases and the TZ cancer cases regarding age, PSA, prostate volume, PSA density, cancer volume, and Gleason scores. PSA failure was observed in 9 PZ cancer cases, and 2 TZ cancer cases. (Conclusion) Based on our findings, the prognosis of TZ cancer cases was better than that of PZ cancer cases among the radical prostatectomy cases with PSA greater than 20 ng/ml. Radical prostatectomy might be one of the effective treatment option for TZ cancer even if the PSA shows greater than 20 ng/ml. It seems to be important to detect TZ cancer properly based on DRE and TRUS findings.