目的:提高对少见的前列腺混合型肿瘤的认识.方法:分析5例前列腺混合型恶性肿瘤患者的临床资料,并结合文献讨论前列腺混合型恶性肿瘤的诊疗方法.结果:前列腺混合型小细胞癌和腺癌1例,予以经尿道前列腺汽化电切术(TUVP)术及氟他胺治疗,7个月后死于肺转移.前列腺混合型小细胞癌和腺癌1例,予以TUVP术及睾丸切除术,10个月后死于肺转移.前列腺腺鳞癌1例,予以TU-VP术、放疗及氟他胺治疗,8个月后肺、肝、骨多处转移,死于多脏器衰竭.前列腺腺鳞癌1例,予以膀胱、前列腺切除并尿路改道,已生存1年,仍处于随访中.前列腺癌肉瘤1例,患者行膀胱、前列腺切除并尿路改道及盆腔淋巴结清扫术,术后予以放疗,13个月后出现广泛肺转移,死于肺部并发症.结论:前列腺混合型恶性肿瘤预后差,确诊需经详细病检及免疫组织化学技术.应及时随访经过内分泌或放疗的前列腺腺癌患者,根治性手术是目前治疗前列腺混合型肿瘤最有效的措施.%Objective To improve the awareness of rare mixed prostatic carcinoma. Methods We reviewed the clinical data of 5 patients with prostatic mixed tumor and relevant literature to ex-plore diagnosis and treatment for it. Results Patient 1 with mixed small cell carcinoma and adeno-carcinoma of the prostate who underwent transurethral electrovaporization of the prostate (TUVP) and flumamide therapy died of lung metastasis 7 months later. Patient 2 with mixed small cell carcinoma and adenocarcinoma of the prostate who underwent TUVP and bilateral testicular resection died of lung metastasis 10 months later. Patient 3 with adenosquamous carcinoma of the prostate who underwent TUVP, radiation therapy and flumamide therapy died of multiple organ failure 8 months later because of the lung, liver, and multiple bone metastasis. Patient 4 with prostatic adenosquamous carcinoma who underwent cystoprostatectomy combined with urinary diversion has already survived for 1 year. Patient 5 with prostatic carcinosarcoma who underwent cystoprostatectomy, urinary diversion, pelvic lymphadenectomy, and radiation therapy died of lung metastasis 13 months later. Conclusion Mixed prostatic carcinoma is quite aggressive with bad prognosis. Its diagnosis relies on detailed pathological examination and immunohistochemical techniques. Patients with prostate adenocarcinoma should be followed up timely after endocrine treatment or radiotherapy. Radical surgery is most effective for mixed prostatic carcinoma.
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