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目的:探讨前列腺特异性抗原(PSA)筛查在会阴Paget病中的价值。方法:回顾性分析2003年1月~2012年12月在我院治疗的63例会阴Paget病患者临床资料。本组患者术前均行PSA检测,对于血清PSA>4μg/L者行经直肠超声引导下前列腺穿刺活检术以明确病理诊断。将本组患者中PSA>4μg/L者所占比例和前列腺癌(PCa)的发生率分别与文献报道的一般人群中相应比例进行比较。结果:本组63例患者均经病理证实为Paget病。19例(30.2%)患者肿瘤浸润至真皮层,2例(3.2%)累及提睾肌,4例切缘阳性。术前血清PSA>4μg/L者14例,在全组患者中所占比例(22.2%),明显高于一般人群中PSA筛查时血清PSA>4μg/L的比例(6.7%)。14例血清PSA>4μg/L的Paget病患者中6例(42.9%)经前列腺穿刺活检证实合并有PCa,其发生率远高于PSA>4μg/L的一般人群中PCa的发生率(25%~30%)。结论:与一般人群相比,会阴Paget患者更容易发生PCa,其具体机制有待进一步研究。
Objective: To investigate the value of prostate specific antigen (PSA) screening in perineal Paget disease. Methods: The clinical data of 63 cases of perineal Paget disease treated in our hospital from January 2003 to December 2012 were analyzed retrospectively. This group of patients underwent preoperative PSA test for PSA> 4μg / L underwent transrectal ultrasound-guided prostate biopsy to confirm the pathological diagnosis. The proportion of patients with PSA> 4μg / L and the incidence of prostate cancer (PCa) were compared with those in the general population reported in the literature. Results: 63 patients in this group were pathologically confirmed as Paget disease. Tumors were infiltrated into the dermis in 19 patients (30.2%), cremaster muscle in 2 patients (3.2%), and positive margins in 4 patients. Preoperative serum PSA> 4μg / L in 14 cases, the proportion of all patients (22.2%), significantly higher than the general population PSA screening serum PSA> 4μg / L ratio (6.7%). Of the 14 Paget patients with PSA> 4 μg / L, 14 (42.9%) had PCa confirmed by prostate biopsy, which was significantly higher than that of PCa (25%) in the general population with PSA> 4 μg / ~ 30%). Conclusion: Compared with the general population, perineal Paget patients are more prone to PCa, its specific mechanism needs further study.