前立腺偶発癌の治療の検討

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前立腺肥大症191例中14例に偶発癌が発見された.組織検査で8例が限局性の高分化型のstage A1, 2例が限局性の中分化型,2例がびまん性の高分化型,2例がびまん性の未分化型で合計6例がstage A2であった.限局性のstage A1は無治療で,限局性のstage A1とA2の5例はCMAの投与で,びまん性のstage A2の4例は前立腺全摘出術と骨盤リンパ節郭清を行った.3例の摘除組織に癌が残存していたが,その内1例で被膜を穿通していた.観察期間は1.5～7年(平均43ヵ月)である.stage A1の症例は無治療で経過して再発はなかった.stage A2の症例は前立腺全摘出により癌の再発なく生存している.stage A2の症例にはstage BやCが含まれる可能性があり積極的な治療が必要であるFourteen patients with incidentally diagnosed carcinoma of the prostate were reviewed. The frequency of the incidental prostatic carcinoma in our clinic was approximately 7.3% of 191 patients operated for benign prostatic hypertrophy. Five patients with focal and well differentiated carcinoma (stage A1) were managed expectantly with no treatment. Two patients with focal and moderately differentiated carcinoma (stage A2) and three patients with stage A1 cancer were treated by means of chlormadinone acetate. Total retropubic prostatectomy and pelvic lymph-node dissection was performed in four patients with diffuse prostatic carcinoma (stage A2). No serious complication occurred without minimal stress incontinence in one patient. Three patients had diffuse residual carcinoma in the total prostatectomy specimens. In one of them capsular penetration of carcinoma cells was discovered. Follow up was performed for 1.5-7 years (mean 43 months) by repeated transrectal needle biopsy, bone scan and serum phosphatase. Metastasis and recurrence have not developed in any patient. Two patients died without evidence of cancer. The remaining patients are alive without evidence of disease. Radical operation is recommended for patients with stage A2 prostatic carcinoma after transurethral resection of prostate.

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斎藤清
秦野赤十字病院

前立腺偶発癌の治療の検討

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