前列腺癌的跳跃式转移

目的:提高对仅有骨外器官转移的晚期前列腺癌患者的诊治水平。方法:2例因体检发现肺脏和肝脏有转移癌灶的患者,进一步检查仅发现血PSA升高。经前列腺穿刺活检,病理证实为前列腺癌,MRI示前列腺包膜连续性消失,ECT检查骨骼无异常。遂用LHRHa联合抗雄药物行诊断性内分泌治疗,一例病人在12个月时行手术去势。分别于15个月和18个月时行前列腺调强放疗一疗程(80Gy)。结果:经内分泌治疗3个月时,肝、肺多发转移灶消失或明显缩小,6个月时转移灶均消失,PSA水平1例维持在0.02μg/L以下,1例维持在0.5μg/L左右。放疗后停用药物治疗,随访12个月,肝、肺扫描正常,骨扫描正常,PSA均维持在1.0μg/L以下。结论:前列腺癌的远处转移可首先出现在骨骼以外器官,在诊断时应重视对骨外器官的检查。患者经综合治疗后效果良好。

Skip Metastasis of Prostate Cancer:Diagnosis and Treatment

Objective:To improve the diagnosis and treatment of far advanced prostate cancer without clinically detectable bone me-tastasis. Methods:Cancer metastatic lesions were found in the liver and lungs respectively of two patients on routine medical exami-nation,and only an abnormally elevated level of the serum prostate specific antigen(PSA)was observed in the following system exami-nations.The patients were diagnosed as having prostate cancer by prostate biopsy.MRI showed a discontinued prostate capsule,and ECT revealed no bone metastasis.Diagnostic treatment was conducted by giving LHRHa combined with antiandrogens.One of the pa-tients underwent surgical castration at 12 months,and both received intensity modulated radiation therapy(80 gy)at 15 and 18 months,respectively. Results:The metastatic lesions in the liver and lungs of the patients were either absent or significantly reduced after treated by maximal androgen blockade for 3 months,and all disappeared after 6 months'treatment,with the PSA level stabilized at less than 0.02μg/L in one patient,and around 0.5μg/L in the other.Antiandrogen treatment was suspended after radiotherapy.The results of liver,lung and bone scanning were normal during the 12-month follow-up,and the PSA level was below 1.0μg/L. Con-clusion:Remote metastasis of prostate cancer may occur in ectosteal organs first,which deserves special attention.A combination of different treatment methods promises satisfactory results.