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目的探讨血清PSA<4.0ng/ml的人群中前列腺癌的病理学特征。方法对长春市15192名男性进行血清前列腺特异性抗原(PSA)检测,其中46名血清PSA<4.0ng/ml伴有直肠指诊检查异常者接受了经直肠超声引导下前列腺6点活检穿刺,并应用组织病理学、免疫组织化学及统计学等方法进行系统的病理学研究和分析。结果(1)血清PSA<4.0ng/ml者有13886名,46人进行了前列腺活检穿刺,活检率为0.33%(46/13886)。(2)46名男性血清PSA值在0.03～3.84ng/ml之间,主要分布在0～1.9ng/ml间,占60.9%。(3)46例前列腺活检病理诊断:良性前列腺增生29例,占63.1%;前列腺癌10例,占21.7%;炎症性病变与肉瘤各3例,分别占6.5%;转移癌1例占2.2%。10例血清PSA<4.0ng/ml的前列腺癌中普通型腺癌5例,以中分化(3/5)、器官内癌(4/5)为主,且血清PSA值较靠近4ng/ml;特殊类型前列腺癌5例,占50%,均为进展期癌,血清PSA值相对较低。结论(1)血清PSA<4.0ng/ml的人群中有前列腺癌存在。(2)血清PSA<4.0ng/ml的人群中前列腺癌以中分化器官内腺癌和特殊类型进展期前列腺癌为主。(3)应用直肠指诊检查(DRE)能检出血清PSA<4.0ng/ml的前列腺癌,且检出率与血清PSA值成正相关,两者联合应用可以提高前列腺癌的检出率。
Objective To investigate the pathological features of prostate cancer in people with serum PSA <4.0 ng / ml. Methods Serum PSA was detected in 15192 males in Changchun. Among them, 46 patients with PSA <4.0 ng / ml had abnormalities in the digital rectal examination and underwent transrectal ultrasound-guided 6-point prostate biopsy. Application of histopathology, immunohistochemistry and other methods of systematic pathology research and analysis. Results (1) There were 13886 patients with serum PSA <4.0ng / ml and 46 patients underwent prostate biopsy. The biopsy rate was 0.33% (46/13886). (2) The serum PSA levels of 46 males ranged from 0.03 to 3.84ng / ml, mainly ranging from 0 to 1.9ng / ml, accounting for 60.9%. (3) 46 cases of prostate biopsy pathological diagnosis: benign prostatic hyperplasia in 29 cases, accounting for 63.1%; 10 cases of prostate cancer, accounting for 21.7%; 3 cases of inflammatory lesions and sarcomas, accounting for 6.5%; 1 case of metastatic cancer accounted for 2.2% . 5 cases of common type adenocarcinoma in 10 cases of prostate cancer with serum PSA <4.0ng / ml were moderately differentiated (3/5), intracranial carcinoma (4/5), and serum PSA was closer to 4ng / ml; Special type of prostate cancer in 5 cases, accounting for 50%, are advanced cancer, serum PSA value is relatively low. Conclusions (1) Prostate cancer is present in people with serum PSA <4.0 ng / ml. (2) Prostate cancer in patients with serum PSA <4.0 ng / ml is predominantly of mid-differentiated organ adenocarcinoma and a special type of advanced prostate cancer. (3) The application of digital rectal examination (DRE) can detect the serum PSA <4.0ng / ml of prostate cancer, and the detection rate is positively correlated with the serum PSA, the combination of the two can improve the detection rate of prostate cancer.