前列腺小细胞神经内分泌癌(1例附文献复习)

目的提高对前列腺小细胞神经内分泌癌的认识。方法报告1例86岁高龄前列腺小细胞神经内分泌癌患者,有血尿伴排尿困难症状,肛指检查示前列腺增生,质地中等,前列腺特异性抗原(PSA)正常,为0.867ng/m L,B超示:双肾积水,双侧输尿管全程扩张,膀胱内较多血块,前列腺增生。结合文献分析发病情况、发病机制、临床特征、诊断、治疗及预后。结果全身麻醉下行经尿道膀胱泵洗及经尿道前列腺电切术。前列腺电切病理结果显示小细胞神经内分泌癌。术后CT疑胰腺有转移病灶,9d后死于晚期肿瘤。结论前列腺小细胞神经内分泌癌为罕见病,临床症状不典型,主要为血尿及排尿困难,需行病理检查确诊;由于治疗方法有限,生存期较短,预后差。     

前列腺小细胞癌2例报告及文献复习

目的:探讨前列腺小细胞癌的临床病理特征,提高其临床诊治水平。方法:通过2例前列腺癌治疗后转化为前列腺小细胞癌的病例报告并复习相关文献。结果:2例患者因PSA升高行前列腺穿刺,病理诊断均为前列腺癌,均行最大限度雄激素阻断治疗,治疗后PSA降至正常水平;后因排尿困难行前列腺电切术,术后病理诊断为前列腺小细胞癌,行化疗或放疗,于发现小细胞癌后8～9个月死亡。结论:前列腺小细胞癌可由前列腺腺癌治疗后转化而来,病理转化最可能的机制是长期内分泌治疗所诱发突变。前列腺小细胞癌较前列腺腺癌恶性程度高,预后差。     

前列腺小细胞癌二例报告并文献复习

目的探讨前列腺小细胞癌的临床、病理特征及治疗方法。方法总结2例前列腺小细胞癌患者的临床资料并进行文献复习。例1,50岁,因排尿困难伴会阴部疼痛3个月入院。直肠指检前列腺Ⅲ度(5．0 cm×6．0 cm)增生,质硬,表面欠光滑。血清PSA 0．31 ng／ml,fPSA 0．09ng／ml。B超示低回声块,CT示前列腺密度不均。经直肠穿刺活检示前列腺癌,行前列腺癌根治术。例2,82岁,因排尿困难伴间歇性血尿4个月入院。直肠指检前列腺Ⅱ度(4．0 cm×5．0 cm)增生,质硬伴多发性结节,表面欠光滑。血清PSA 2．61 ng／ml,fPSA 0．05ng／ml。B超示低回声块,CT示前列腺密度不均,精囊及膀胱颈部受侵犯。经直肠穿刺活检示前列腺小细胞癌,行双睾切除术加TURP。结果2例术后病理均诊断为前列腺小细胞癌。肿瘤呈弥漫性片巢状结构,伴大片凝固性坏死,核小、燕麦状或圆形、染色深、核仁不明显、胞质少,类似肺小细胞癌。精囊及膀胱颈部均有肿瘤细胞浸润。免疫组化染色检查:LCA、L-26、34βE12(-),PSA、AE1／AE3、AR(+),CA、S-100(±)。例1术后1个月死于广泛肺转移,例2术后3个月发现后腹膜转移,仍在随访中。结论前列腺小细胞癌少见,确诊依靠临床及病理表现。对早期前列腺小细胞癌,根治性前列腺癌切除术加激素及化疗是可行的,晚期患者则无较满意的治疗方法,且预后差。     

前列腺小细胞癌诊疗体会(附2例报告)

目的:探讨前列腺小细胞癌的临床表现、诊断方法、病理特征及治疗方法,以期提高对前列腺小细胞癌的进一步认识。方法:回顾性分析2017年11月至2018年3月收治的2例确诊前列腺小细胞癌的临床及病理资料,并复习相关文献。结果:2例患者均有排尿困难症状,PSA均有升高,前列腺触诊有II°～III°增大,其中1例行前列腺穿刺活检,1例行经尿道前列腺部肿瘤1470激光汽化切除术。术后病理均提示前列腺腺癌伴前列腺小细胞癌,1例患者行EP方案化疗,于确诊20个月后死于全身多器官功能衰竭;1例患者行内分泌治疗,目前带瘤存活。结论:前列腺小细胞癌发病率低,恶性程度高。确诊后平均生存期约7～10个月,目前仍无可靠治疗方案,现基本参照肺小细胞癌的治疗经验,仍以化疗为主,该病预后较差,治疗效果多不满意。     

前列腺小细胞癌诊治再分析

目的 探讨前列腺小细胞癌的组织学特性、临床表现、治疗以及预后。 方法 报告2例前列腺小细胞癌患者的临床、病理和随访资料,复习相关文献并进行讨论。 结果 2例术后病理检查均诊断为前列腺小细胞癌。术前均经直肠前列腺穿刺活检确诊为前列腺小细胞癌,切片可见肿瘤呈弥漫性巢状结构,细胞小,胞质少,核染色深,核仁不明显,可见燕麦形小细胞,伴凝固性坏死。免疫组化示：PSA、PAP阴性;NSE阳性。例1行前列腺姑息切除术并行EP（VP-16,顺铂）方案化疗,6个月后因肿瘤复发及全身转移死亡。例2行前列腺姑息切除术并行口服比卡鲁胺治疗,3个月后因颅内病灶复发及肝转移死亡。 结论 前列腺小细胞癌具有浸润性生长的生物学特性,恶性程度高,预后不良。确诊依赖病理学检查,早期行根治术并联合放化疗是目前治疗最有效的方法。     

前列腺小细胞神经内分泌癌患者一例报道并文献复习

目的探讨前列腺小细胞神经内分泌癌的临床诊断和治疗。 方法回顾性分析我院收治的1例前列腺小细胞神经内分泌癌患者的资料。结合相关文献讨论前列腺神经内分泌肿瘤的病理学分型、临床表现、影像学特征、诊治和预后。 结果患者男性,64岁,2014年9月因发现PSA 52.72 μg/L,前列腺穿刺活检提示前列腺腺泡腺癌,Gleason评分3+4=7分,予手术去势,后联合持续抗雄治疗（比卡鲁胺50 mg qd）。2017年5月复查发现盆腔巨大肿物伴肠梗阻,全身多发骨转移、肝脏转移、肺转移。予盆腔肿物切除+横结肠造瘘,术后病理提示前列腺小细胞内分泌癌。患者术后2周开始予多西他赛100 mg d1+卡铂450 mg d1,化疗2周期后因多脏器功能衰竭去世。 结论前列腺癌伴神经内分泌分化为最常见的前列腺神经内分泌肿瘤,前列腺小细胞癌临床罕见,早期手术联合化疗为主要治疗手段,肿瘤恶性程度高、进展快,预后差。     

前列腺小细胞癌3例报告并文献复习

目的 探讨前列腺小细胞癌的临床、病理特征及治疗方法.方法 回顾性分析3例前列腺小细胞癌患者的临床资料并复习文献.结果 2例术后病理诊断为前列腺小细胞癌,1例经直肠穿刺活检示前列腺小细胞癌,切片见肿瘤呈弥漫性片、巢状结构,伴大片凝固性坏死.核小、燕麦状或圆形、染色深、核仁不明显、胞质少,类似肺小细胞癌.例1行免疫组化染色检查:LCA、L-26、34 B E12、P504s(-),PSA、AE1/AE3、AR(+),CA、S.100(±).例l术后3个月死于全身广泛转移,例2术后13个月死于肺转移,例3术后5个月,仍在随访中.结论 前列腺小细胞癌是一种少见的高度恶性的肿瘤,确诊主要依靠病理诊断,早期即可发生转移,预后较差.目前尚无较满意的治疗方法.     

雄激素阻断治疗后前列腺腺癌转化为小细胞癌1例报告并文献复习

目的：探讨前列腺小细胞癌的临床、病理特征及诊治方法．方法：分析1例前列腺小细胞癌患者的临床资料：患者男．54岁。因“尿频、尿急、排尿困难1个月”入院。直肠指诊前列腺Ⅲ。大．质硬,表面不光滑。血PSA为175．08ng／ml。B超及MRI检查均提示前列腺癌．前列腺穿刺活检诊断为前列腺腺癌．行最大限度雄激素阻断治疗。9个月后症状加重,复查血PSA为7．4mg／ml。MRI提示前列腺腺癌,行前列腺电切术,病理检查为前列腺小细胞癌。免疫组织化学示CD56（＋）,NSE（＋）,CgA（-）．LCA（-）。遂以GP方案化疗：吉西他滨1800mg,DDP150mg,采用4周方案,一共行4个疗程。从第2个疗程开始同步局部放疗（3D-CRT。每次3Gy,总量60Gy）。结果：复查CT前列腺局部肿瘤消失,排尿通畅,但在随访的过程中。患者死于急性心肌梗死。结论：雄激素阻断治疗后,前列腺腺癌可能转化为小细胞癌,前列腺小细胞癌少见,恶性程度高,确诊需依靠临床及病理表现。强调早发现,早治疗。治疗以化疗为主,可辅以放疗,早期前列腺小细胞癌,也可行前列腺癌根治加化疗。     

前列腺小细胞癌2例病例报告并文献复习

目的 探讨前列腺小细胞癌的临床、病理特点及治疗方法.方法 回顾性分析2例前列腺小细胞癌病例资料并进行文献复习.结果 2例均行前列腺穿刺活检病理提示前列腺小细胞癌,1例全身多发性骨转移,1年后死于多脏器功能衰竭;另1例放弃治疗并自动出院,失访.结论 前列腺小细胞癌临床罕见,恶性程度高,预后差,确诊主要依靠病理诊断.早期应根治性切除+化疗;晚期则无满意的治疗方法,主要是化疗.     

原发性前列腺印戒细胞癌(1例报告并文献复习)

目的探讨原发性前列腺印戒细胞癌的临床特征。方法回顾性分析1例原发性前列腺印戒细胞癌患者的临床资料,并结合文献进行复习讨论。结果患者前列腺穿刺活检病理报告为前列腺印戒细胞癌,免疫组织化学检查示PSA( ),PAS、CEA、LCA、CKH(-),行双侧睾丸切除术和氟他胺治疗,术后1月死于肺部转移。结论原发性前列腺印戒细胞癌来自前列腺腺泡上皮,确诊依靠病理组织学和免疫组化检查。临床罕见,恶性程度高,预后较差。     

Combined small-cell carcinoma/adenocarcinoma of prostate: report of two cases

We report two cases of combined small-cell carcinoma (SCC) and adenocarcinoma of prostate. Case 1 was a 76-year-old man with loss of appetite and body weight and neck lymphadenopathies. Whole body computed tomography (CT) revealed prostatic swelling, pancreatic mass, para-aortic lymphadenopathies, and multiple lung nodules. Elevation of tumor markers (prostate specific antigen [PSA, 1,760 ng/ml] and neuron-specific enolase [NSE, 88 ng/ml]) was noted. Needle biopsy of the prostate demonstrated both SCC and adenocarcinoma. Only within the part of SCC, were neuroendocrine (NE) markers (chromogranin A [CgA], NCAM, and synaptophysin [SNP]) expressed. Maximum androgen blockade (MAB) resulted in a decrease of PSA (5.13 ng/ml) but an increase of NSE (810 ng/ml). Cytotoxic chemotherapy was not possible because of his poor performance state and renal dysfunction. The patient died three months after the diagnosis. Case 2 was a 69-year-old male with dysuria. The symptom and elevated serum PSA (23.1 ng/ml) prompted prostatic needle biopsy, which demonstrated combined SCC/adenocarcinoma. NE markers (CgA and SNP) were weakly expressed in the part of SCC. Serum NSE was 6.9 ng/ml. After MAB, serum PSA dropped to the normal range (0.192 ng/ml) and the effect of MAB was judged as complete response (CR). The patient has been alive for 15 months with no signs of relapse. Treatment of combined SCC and adenocarcinoma of prostate poses a dilemma. In Case 1, MAB was effective for adenocarcinoma but not for SCC. The opposite situation would be expected with systemic chemotherapy. However, the histologically similar Case 2 achieved CR with MAB alone. Much remains to be elucidated to better manage combined SCC/adenocarcinoma of prostate.     

Prostatic carcinoma that arose with hearing loss: a case report

A 69-year-old male with tinnitus, vertigo, and progressive hearing loss of left ear was admitted to our hospital. Head magnetic resonance imaging and computed tomography (CT) revealed swelling of multiple neck lymph nodes (LNs) invading the skull base, which involved left mastoid sinus/the eighth cranial nerve. Biopsy of the cervical LN demonstrated small-cell carcinoma (SCC). Whole body CT showed systemic lymphadenopathies (subclavian, para-aortic, and bilateral iliac LNs) and prostatic swelling with multiple pelvic masses. Needle biopsy of the prostate revealed SCC (Gleason score: 5+ 5). Immunohistochemically, neuron-specific enolase (NSE) and NCAM were detected in <10% and -100% of cancer cells, respectively. Despite SCC histology, prostate-specific antigen (PSA) and androgen receptor (AR) were also expressed in -20% and -70% of tumor cells, respectively. Serum PSA and NSE were 464 ng/ml and 12 ng/ml, respectively. After maximum androgen blockade (MAB) with leuprorelin/bicalutamide, the patient showed recovery of hearing loss, regression of cervical LNs (partial response), and decline of serum markers (PSA 7.38 ng/ml and NSE 3.7 ng/ml, respectively). As re-increase of PSA was observed after ten months, MAB menu was changed to leuprorelin/fultamide. Another four months later, the treatment was changed to docetaxel/ estramustine due to the appearance of systemic bone pain and recurrence of LN metastases. He is alive (39 months after diagnosis) with cancer. Widespread metastases at the time of diagnosis were compatible with SCC. However, this case was AR-positive and responded to androgen ablation, at least temporarily. Even though the initial symptoms are atypical for a prostatic carcinoma, SCC of prostate needs to be included as a rare differential diagnosis.     

Primary squamous cell carcinoma of the prostate

BACKGROUND: Primary squamous cell carcinoma (SCC) is an uncommon tumor of the prostate gland. A 65-year old man complained of obstructive symptoms. METHODS/RESULTS: Transrectal palpation and diagnostic imaging indicated an ordinary adenocarcinoma, although serum prostate-specific antigen (PSA) was normal. Biopsy specimens revealed SCC with the serum SCC antigen elevated. The patient was treated with pelvic irradiation and systemic administration of cis-platinum and peplomycin, which resulted in shrinkage of the cancer. CONCLUSION: No evidence of recurrence has been seen for 18 months.     

Small cell carcinoma of the prostate: Three case reports and a literature review

Small cell carcinoma (SCC) of the prostate is a high-grade malignant neoplasm with neuroendocrine differentiation and accounts for only 0.5–2% of all prostate cancers. From 2005 to 2010, there were a total of three cases of SCC at our hospital. The disease onset age was 61, 74, and 84 years, respectively. Initial presentations include urinary difficulty, bone pain, and gross hematuria. One patient had mixed tumors of both SCC and adenocarcinoma, and two had prior adenocarcinomas that recurred as SCC. The diagnosis of SCC was all made via transurethral resection. Two patients died of their diseases 7 and 15 months after diagnosis, and one survived for more than 65 months. The serum prostate specific antigen (PSA) was 1660 ng/mL, 72.8 ng/mL, and 35.7 ng/mL before definitive diagnosis. Notably, the only surviving patient was diagnosed with SCC after the transurethral resection of prostate because of the presence of lower urinary tract symptoms. The serum PSA prior to the operation was 0.11 ng/mL, and he received chemotherapy with 5 courses of cisplatin and VP-16. Palliative transurethral resection of the prostate (TURP) not only solved the obstructive symptoms of voiding but helped in removing the prostate tissue, which might have the SCC component in patients with prostate adenocarcinoma under androgen deprivation therapy.     

Effect of high-grade prostatic intraepithelial neoplasia on total and percent free serum prostatic-specific antigen

OBJECTIVE: To analyze the influence of high-grade prostatic intraepithelial neoplasia (HGPIN) on total serum prostatic-specific antigen (PSA) and percent free PSA. METHODS: Total and free serum PSA were determined in 81 consecutive patients with clinical T1c prostate cancer who underwent radical prostatectomy. HGPIN was detected in 62 specimens (76.5%). RESULTS: Median total PSA was 9.2 ng/ml when there was not HGPIN and 8.1 ng/ml when it existed, p>0.05. Median percent free PSA was 11.7 and 9.1%, respectively, p<0.03. However, a multiple linear regression analysis demonstrated there was no effect of HGPIN on total PSA nor on percent free PSA. Percent free serum PSA was significantly influenced by total PSA and the pathological tumor stage. CONCLUSION: HGPIN does not seem to contribute significantly on serum total PSA and percent free PSA.     

Using multiple cutpoints for the free-to-total prostate specific antigen ratio improves the accuracy of prostate cancer detection

BACKGROUND: Using a single cutpoint for the free-to-total (F/T) prostate specific antigen (PSA) ratio loses important diagnostic information. We evaluated the performance of multiple F/T PSA cutpoints in detecting prostate cancer in men with nonspecific PSA values. METHODS: We extracted sensitivity and specificity data from 12 studies reporting on >or=30 cancer patients with PSA values between 2.0 and 10.0 ng/mL. We calculated stratum-specific likelihood ratios (LR) and areas under the receiver operating characteristic (ROC) curves. RESULTS: Multiple cutpoints for the F/T PSA ratio significantly increased the area under the ROC (0.70) compared with the single investigator-selected cutpoint (0.62), P < 0.004. The LR for the most positive cutpoint stratum (2.62) was significantly higher than the LR for a positive test from the single cutpoint (1.36), P < 0.004. CONCLUSIONS: Using multiple cutpoints increased the discriminating power of the F/T PSA ratio and led to greater probability revisions in the most positive test-result strata.     

Rye bran and soy protein delay growth and increase apoptosis of human LNCaP prostate adenocarcinoma in nude mice

BACKGROUND: In this study, we investigated whether dietary intervention could inhibit tumor growth of an androgen-sensitive human prostatic cancer. METHODS: LNCaP cells were transplanted subcutaneously in nude-mice. The animals were then put on different diets and tumor take, tumor growth and prostate specific antigen (PSA) secretion were studied during 9 weeks. RESULTS: Palpable tumors developed in 75% of the tumor-cell injected sites in animals fed a control diet (corn starch, sucrose, etc.) whereas, for animals given rye bran (RB), ethyl acetate extraction from rye bran supplemented cellulose based diets (CCEE), palpable tumors were seen in only 30% and for soy protein based diets (SCC) 50% of the transplantation sites, respectively. The tumors that grew to palpable size in the rye (RB) and soy (SCC) groups were smaller and secreted less PSA than those in the control group. In the rye and soy groups tumor cell apoptosis was increased, but cell proliferation was unaffected. Addition of fat to the rye diet reduced its effect on prostate cancer growth. CONCLUSIONS: Factors in rye bran and soy protein may inhibit prostate cancer growth. The effect is more apparent for rye than for soy. Further studies are needed to identify the effective substances and to explore the mechanism of action.     

Multiple myeloma diagnosed during hormonal therapy for prostate cancer: report of two cases

Case 1: A 73-year-old man presented with a serum prostate specific antigen (PSA) level of 30.2 ng/ml, and was diagnosed with prostate cancer (cT3aN0M1, stageD2), for which hormonal therapy (maximal androgen blockade : MAB) was commenced. Nine months later he developed back pain, and osteolytic bone lesions progressed despite a stable, low PSA level (0.087 ng/ml). He was diagnosed with multiple myeloma on the basis of positive M protein on immunoelectrophoresis. MP combination therapy (melphalan and prednisolone) was commenced, but the patient died of multiple myeloma 33 months later. Case 2: A 70-year-old man was diagnosed with prostate cancer (PSA 19 ng/ml) at another hospital 5 years ago, and underwent hormonal therapy (luteinizing hormone-releasing hormone (LHRH) agonist only). He was referred to our hospital and underwent bicalutamide+MAB combination therapy due to a raised PSA level (58 ng/ml) and multiple bone metastases. His PSA level dropped to around 20 ng/ml, but 2 years later he developed back pain, and bone metastases with osteolytic change were seen in the skull, ribs, and limbs. Needle aspiration biopsy of a fist-sized soft tissue mass in the chest wall showed multiple myeloma. Although chemotherapy with melphalan was commenced, the patient died of multiple myeloma 8 months after its diagnosis. Both these cases exhibited rapidly progressing bone lesions, regardless of an absence of any large fluctuations in serum PSA levels, during hormonal therapy for prostate cancer. Further investigations yielded the diagnosis of multiple myeloma. If progression of bone lesions does not match the status of prostate cancer as surmised from the serum PSA level, we should consider the possibility of multiple myeloma, and biopsy of one of the bone lesions.     

PSA in the new millennium: a powerful predictor of prostate cancer prognosis and radical prostatectomy outcomes--results from the SEARCH database

OBJECTIVES: As a result of prostate-specific antigen (PSA) screening, most men today with prostate cancer present with localized disease and serum PSA values < 10 ng/ml. Within this context, it is debated whether PSA remains an important prognostic variable in more recently treated patients. We examined the prognostic significance of preoperative PSA to predict pathologic stage and biochemical progression among men undergoing radical prostatectomy in the new millennium (2000-2006). METHODS: We performed a review of 925 men with prostate cancer treated by radical prostatectomy since 2000 within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. We examined the association between preoperative PSA and risk of adverse pathologic features and biochemical progression using logistic regression and Cox proportional hazards analysis. RESULTS: After adjusting for multiple clinical preoperative characteristics, higher preoperative PSA values were associated with increased odds of extracapsular extension (p<0.001), positive surgical margins (p<0.001), and seminal vesicle invasion (p<0.001) and increased risk of biochemical progression (p=0.009). When the analyses were limited to the 690 men with a preoperative PSA<10 ng/ml and after adjusting for multiple clinical characteristics, higher preoperative PSA values remained associated with increased risk of biochemical progression (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.06-1.28, p=0.002). Even among the 448 men with a PSA<10 ng/ml and clinical stage T1c disease, preoperative PSA was associated with increased risk of biochemical progression (HR 1.14, 95%CI 1.00-1.31, p=0.047). CONCLUSIONS: PSA remains an important prognostic marker among men diagnosed with prostate cancer in the new millennium treated with radical prostatectomy and remains an important predictor of outcome even among men with preoperative PSA level < 10 ng/ml.     

Effect of haemodialysis on serum levels of tumour markers in patients with end-stage renal failure

SUMMARY: We studied the effect of haemodialysis on the serum levels of tumour markers in 78 patients, 49 men and 29 women with a mean age of 61 ± 2 years, who had been undergoing haemodialysis for 39 ± 10 months. No patient had any clinical evidence of malignancy. Serum values of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), squamous-cell-carcinoma-related antigen (SCC), neuron-specific enolase (NSE), tissue polypeptide antigen (TPA), CA 15-3, CA 19–9, and among males prostate-specific antigen (PSA) were determined before and after dialysis. Postdialysis values, after being corrected for haemoconcentration, were compared with predialysis values. A significant increase of 32% was observed in NSE levels ( P <0.001) and of 21% in CA 15-3 ( P <0.001) after haemodialysis. A lesser, but still statistically significant, increase (8-12%) was observed in SCC, AFP and CEA levels ( P <0.05), while the values of the remaining three markers remained unchanged. In conclusion, an increase in some tumour markers was found in our patients after dialysis, a finding which requires further investigation.