前立腺偶発癌の検討 [in Japanese] CLINICAL STUDY FOR INCIDENTAL PROSTATIC CARCINOMA [in Japanese]
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1979年より1986年までに千葉大学および旭中央病院泌尿器科にて前立腺肥大症(Benign prostatic hypertrophy, BPH)として被膜下摘除術ないし経尿道的前立腺切除術(Transurethral resection of the prostate, TURP)を施行したものは,それぞれ643例および623例,計1,266例であり,そのうち偶発癌と判明した73例(5.8%)について検討を加えた.被膜下摘除術では,偶発癌は26例(4.0%)あり,A_1 13例,A_2 13例であった.TURPでは,47例(7.5%)の偶発癌が発見され,A_1 26例,A_2 21例であった.合計すると偶発癌は73例であり,そのうちA_1 39例,A_2 34例であった.A_1とA_2平均年齢に差をみなかった.被膜下摘除術では,A_1とA_2の平均摘除重量は,後者がやや大きかったが統計的有意差はなかった.TURPでは両者はほぼ同じであった.A_2は高および中分化型がそれぞれほぼ半数づつを占め,低分化癌は少なかった.A_2のうち無治療3例,不十分な内分泌療法をうけた1例,計4例が臨床癌となり,それらの組織学的分化度は,中分化型3例,低分化型1例で,A_2と診断後,臨床癌までは,平均3年であった.A_1には治療,無治療に関係なく進展したものはなかった.以上よりA_1は無治療でよいが,A_2にはなんらかの治療を要すると結論した
At the Chiba University Hospital and Asahi General Hospital between 1979 and 1986, 1266 cases of benign prostatic hypertrophy were treated by prostatectomy (mainly retropubic) (643 cases) or transurethral resection of the prostate (TURP) (623 cases), and their histological examinations were performed. Twenty-six cases (4.0%) of incidental carcinoma were detected by prostatectomy; 13 and 13 cases were in stage A_1 and A_2, respectively. Forty-seven cases (7.5%) of incidental carcinoma were detected by TURP; 26 and 21 cases were in stage A_1 and A_2, respectively. As a result, 73 cases (5.8%) of incidental carcinoma were detected; 39 and 34 cases were in stage A_1 and A_2, respectively. There were no differences between the mean age of stage A_1 and that of A_2. The mean weight of specimens categorized as A_2 seemed to be large when compared with that as A_1, but no differences were noticed. The mean weight of specimens obtained by TURP in A_1 was similar to that in A_2. The grade in A_2 were 47%, 47% and 6% in the order of highly, moderately and poorly differentiated adenocarcinomas. Four cases of A_2, 3 moderately and 1 poorly differentiated, progressed into clinical carcinoma; 3 of which had no treatment postoperatively and the last one received inadequate endocrine therapy. In these cases, the mean period between diagnosis of A_2 and clinical carcinoma was 3 years. In A_2 that received full treatments, no clinical carcinomas were found up to 8 years. On the contrary, A_1 cases showed no progression irrespective of the presence or absence of treatments. It is concluded that stage A_2 should be treated further, while A_1 may be observed without treatment.
- The Japanese Journal of Urology
The Japanese Journal of Urology 79, 1745-1750, 1988
The Japanese Urological Association