低血清PSA型前列腺癌的回顾性研究

目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。     

中晚期前列腺癌去势联合伽玛刀治疗

目的总结伽玛刀结合去势手术治疗中晚期前列腺癌疗效。方法15例前列腺癌患者,比较双侧睾丸切除 伽玛刀治疗前后PSA、排尿症状评分、残余尿最、尿流率、治疗并发症发生率,0．5-2年后前列腺体积变化。结果双侧睾丸切除后1周,PSA迅速下降至原基础值一半,伽玛刀治疗一疗程后,PSA下降至4．0μg／L以下,最大尿流率增加,国际前列腺症状评分下降,残余尿量减少,放疗后6个月复查肿瘤明显缩小或消失, 0．5-1年、1-2年后复查前列腺体积缩小。治疗无明显并发症。结论中晚期前列腺癌伽玛刀配合去势治疗,不仅能使肿瘤消退,缓解癌细胞生长,减慢病情进展,消除转移灶,而且能显著改善排尿症状,使前列腺体积缩小,无明显放射并发症。     

177Lu-PSMA放射性配体治疗在转移性去势抵抗性前列腺癌的应用初探

目的:评估¹⁷⁷Lu-PSMA放射性配体治疗在转移性去势抵抗性前列腺癌的安全性及初步疗效。方法:收集2017—2020年空军军医大学西京医院收治并接受¹⁷⁷Lu-PSMA放射性配体治疗的转移性去势抵抗性前列腺癌患者,对其中3例典型患者的临床资料进行回顾性分析。结果:病例1确诊前列腺癌后,分别先后予以前列腺癌根治术、双侧睾丸切除术、放疗、转移灶切除+粒子植入术,PSA有效控制10余年后持续上升,⁶⁸Ga-PSMA PET/CT提示多发淋巴结及骨转移,行2个周期¹⁷⁷Lu-PSMA放射性配体治疗后,PSA由2092 ng/mL下降至920 ng/mL,治疗前后血红蛋白、白细胞、肝肾功无明显变化。病例2术前行⁶⁸Ga-PSMA PET/CT发现2处骨转移灶,新辅助内分泌治疗6个月后行前列腺癌根治术,术后PSA逐渐升高,影像学检查发现转移灶增加,行3个周期¹⁷⁷Lu-PSMA放射性配体治疗,复查⁶⁸Ga-PSMA PET/CT转移灶缩小,病灶...     

前列腺癌新辅助治疗临床分析（附32例报告）

目的 总结32例前列腺癌患者新辅助治疗（NHT）的作用。方法 32例前列腺癌患者中药物去势17例，手术去势15例，并联合抗雄激素治疗3个月，统计NHT前后前列腺癌体积、肿瘤大小、PSA、FSH、LH和睾酮水平变化。结果 2组NHT后前列腺体积明显变小、肿瘤变小、变软，甚至消失，PSA和睾酮明显下降，药物去势组睾酮水平在耻骨后前列腺癌根治术（RRP）术后2～3个月可恢复正常，而手术去势组RRP术后睾酮呈持续低水平。结论 NHT可明显缩小前列腺体积，降低PSA，有利于手术操作。药物去势对内分泌影响是可逆的，而手术去势内分泌改变不可逆。     

经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌

目的探讨经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌的临床疗效。方法对31例前列腺癌晚期(D)患者采用经尿道前列腺电汽化切除及睾丸切除术,术后3~5d口服氟他胺做全雄激素阻断以及氟他胺加达菲林的药物去势治疗。结果随访3~42个月,生存者29例,2例患者生存超过5年,20例超过1年。其中7例骨转移病灶减少,6例骨痛患者治疗后疼痛消失。前列腺特异性抗原(PSA)从术前的75.37μg/L降至1.34μg/L(术后1个月),3个月后降为0.27μg/L。B超、胸片、骨扫描未见新的转移灶。结论经尿道前列腺癌电汽化切除加全雄激素阻断治疗晚期前列腺癌具有较好的临床疗效。     

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。     

89SrCl2在前列腺癌骨转移治疗中的应用

目的观察89SrCl2 在前列腺癌骨转移中的治疗效果.方法前列腺癌骨转移患者38例.89SrCl2 治疗组(25例)采用去势术加缓退瘤加89SrCl2 ,对照组(13例)采用去势术加缓退瘤治疗,分别于治疗前和治疗后3、6个月测定血清PSA,骨扫描,观察骨痛缓解情况.结果89SrCl2 治疗组有效率92%(23/25),对照组31%(4/13),差异有显著性意义(P<0.05).结论89SrCl2治疗前列腺癌骨转移疼痛效果明显,副作用小,且对前列腺癌骨转移灶有治疗作用.     

镭-223联合新型内分泌治疗在前列腺癌骨转移中的有效性和安全性分析

目的探讨镭-223联合新型内分泌治疗在前列腺癌骨转移患者中的有效性和安全性。方法回顾性分析2021年1月至2022年6月于空军军医大学第一附属医院和西安国际医学中心医院接受镭-223联合新型内分泌治疗的17例转移性去势抵抗性前列腺癌(mCRPC)患者的临床资料。年龄(73.3±8.5)岁, 前列腺特异性抗原(PSA)中位值15.7(3.2, 36.5)ng/ml, 碱性磷酸酶(ALP)中位值131.5(79.0, 430.7)U/L。所有患者骨转移灶数量≥2个且无内脏或淋巴结转移, 骨扫描病灶数量中位值10(8, 15)个。16例(94.1%)存在骨痛症状;美国东部肿瘤协作组(ECOG)评分≥2分9例, 1分2例, 0分6例。17例均接受镭-223治疗(55 kBq/kg, 每4周注射1次, 最多6次), 其中5例联合恩扎卢胺治疗, 8例联合阿帕他胺治疗, 4例联合比卡鲁胺治疗。分析PSA应答(PSA较基线水平下降≥30%且至少维持1个月)率、ALP应答(ALP较基线水平下降≥30%且至少维持1个月)率、疼痛缓解率。治疗后行影像学检查评估, 计算转移病灶客观缓解率, 同时记录治疗相关不...     

前列腺癌伴肾细胞癌内转移1例报告

前列腺癌肾转移极罕见。本文报道1例前列腺癌伴肾癌内转移患者的临床特征和诊治经过。患者, 67岁。因腰背疼痛3个月, 加重伴发热2周于2018年6月就诊, 病理诊断为前列腺腺癌伴骨转移, Gleason评分4+4分, T2N0M1期。腹部CT检查示右肾下极肿物, 约3.0 cm×2.5 cm×2.5 cm, 动脉期明显强化, 考虑右肾癌。行右肾部分切除术。术后病理检查示肾透明细胞癌Ⅱ级, 肾癌组织内见多个小灶前列腺腺泡细胞癌浸润。术后诊断:转移性前列腺癌, 右肾透明细胞癌。术后影像学随访18个月未见右肾肿瘤复发。患者的前列腺癌予药物去势和醋酸阿比特龙治疗, 治疗6个月后出现PSA进展, 先后予多西他赛化疗、锶89治疗, 效果欠佳, 随访至第30个月患者因恶液质死亡。     

PSA、ECT骨显像诊断前列腺癌骨转移的临床价值

目的 :探讨前列腺特异抗原 (PSA)、发射型计算机断层扫描 (ECT)骨显像诊断前列腺癌骨转移的临床价值。方法 :对 6 7例 (骨转移组 4 4例 ,非骨转移组 2 3例 )前列腺癌病人的PSA、ECT与骨转移的关系进行回顾性分析。　结果 :ECT骨显像诊断前列腺癌骨转移的敏感性 91.6 7% ,骨显像表现为单个核素浓聚灶的病人 6例 ,仅 2例为前列腺癌骨转移。骨转移组与非骨转移组的PSA值差异有显著性 (87.2 8μg/Lvs 2 5 .37μg/L ,P <0 .0 1) ;PSA与骨转移的程度正相关 ,PSA <10 μg/L ,骨转移率为 0 ;PSA 10～ 2 0 μg/L ,骨转移率 7.6 9% ;PSA 2 0～ 6 0 μg/L ,骨转移率5 3.33% ;PSA 6 0～ 10 0 μg/L ,骨转移率 91.6 7% ;PSA >10 0 μg/L ,骨转移率 10 0 %。 　结论 :ECT骨显像对前列腺癌骨转移有较高的敏感性 ,但对单个转移灶诊断的特异性不高。对未经治疗的前列腺癌病人 ,PSA <10 μg/L ,前列腺癌骨转移的可能性极小 ;PSA >10 0 μg/L者 ,骨转移的可能性极大     

Prostatic cancer with multiple pulmonary metastases treated successfully with hormonal therapy: a case report

A 66-year-old, man was referred to our hospital for further examination of multiple pulmonary nodules on chest X-ray performed on medical examination. He was referred to our clinic because his chief complaint was poor urinary stream. Prostatic cancer was suspected on digital rectal examination and magnetic resonance imaging. Serum prostatic specific antigen (PSA) level was 134.9 ng/ml. Histological examination of transrectal prostatic sextant biopsy revealed well differentiated adenocarcinoma of prostate. Abdominal computed tomography-scan, gastro-intestinal tract examination and bone scintigraphy demonstrated no other primary lesions or distant metastases. Under the diagnosis of prostatic cancer with multiple pulmonary metastasis, we performed total androgen blockade (TAB) consisting of luteinizing hormone releasing hormone agonist and flutamide following dietylstilbestrol (DES) intravenous injection therapy. After three months, pulmonary nodules disappeared on chest X-ray and PSA level decreased to below 0.1 ng/ml. Pulmonary nodules also disappeared on CT-scan after six months after TAB. He is alive and free from the recurrence for 42 months.     

Metastatic prostatic carcinoma to supradiaphragmatic lymph nodes. A clinicopathologic and immunohistochemical study

We identified 26 cases of metastatic prostatic carcinoma in supradiaphragmatic lymph nodes from 1972-1987. All involved nodes (15 supraclavicular, eight cervical, two axillary, and one mediastinal) were taken from the left side. Of those cases with available data, serum acid phosphatase was normal in five of 21 (24%). Seven of 20 (35%) had no evidence of bone metastases. Rectal examination was normal in eight of 19 cases (42%). While seven cases had a history of prostate cancer, the rest presented with enlarged nodes alone or with simultaneous urinary obstructive symptoms. Eighteen patients died following node biopsy (mean 19.8 months, range 1-46 months). Twenty-two of 26 metastases were high grade and often were not histologically suggestive of prostate carcinoma. In general, immunohistochemical staining for prostate-specific acid phosphatase (PSAP) was more intense than for prostate-specific antigen (PSA), in contrast to several other reports using these antisera. Metastatic prostate carcinoma should be ruled out by using immunoperoxidase for PSA and PSAP in all men over 45 presenting with carcinoma of unknown primary origin in left-sided supradiaphragmatic lymph nodes, even in the absence of bony disease, elevated serum acid phosphatase (SAP), abnormal rectal examination, and a histologic picture suggesting prostate carcinoma.     

Prostate small cell carcinoma: report of two cases that differed in treatment responsiveness

Case 1 : A 76-year-old man with a chief complaint of dysuria had an elevated prostate specific antigen (PSA) level of 24.9. He underwent a transperineal needle biopsy of the prostate, and the histopathological diagnosis was prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1 with multiple lung metastases. He started receiving hormonal therapy. After three months of hormonal therapy, the multiple lung metastases disappeared. Thereafter, the serum PSA level and the tumor volume increased and he died 12 months from the start of therapy. Case 2: A 79-year-old man was referred to our hospital with a chief complaint of dysuria. The serum level of PSA was elevated to 10.4. Transperineal prostate biopsy revealed prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1, and hormonal therapy was started. Subsequently, although his serum PSA level declined, his condition worsened rapidly and he died five months after the start of therapy.     

Prostatic carcinoma presenting as neck lymph node metastases: report of two cases]

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1,700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.     

Small cell carcinoma of the prostate: a case report

A 76-year-old man had been treated with maximum androgen blockade therapy for a poorly-differentiated prostate adenocarcinoma (T3cN1M0, prostate specific antigen (PSA) 65 ng/ml, Gleason Score 4+5=9) since September 2002. By August 2003, his serum PSA levels were undetectable and the lymph node swelling had vanished. However, in December 2004, his serum PSA levels started rising gradually up to 0.66 ng/ml. Radiation therapy on the prostate was then performed (66 Gy). At that time, no metastasis was detected by computed tomography and bone scintigraphy. In August 2005, multiple bone metastases were detected. Immunohistochemical examination of a biopsy specimen from the bone lesion revealed a small cell carcinoma/neuroendocrine cell carcinoma. He died with undetectable PSA levels (less than 0.008 ng/ml) in December 2005. The autopsy showed multiple organ metastases including bone, liver, lungs and others. The immunohistochemical examination revealed pure small cell carcinoma in all metastatic lesions. A precise histological examination of the lungs using a 1 cm serial section could not reveal any tumors compatible with primary lung cancer. We concluded from the clinical history and autopsy findings that his initial poorly-differentiated adenocarcinoma of the prostate dedifferentiated into a pure small cell carcinoma with neuroendocrine differentiation.     

Successful complete androgen blockade (CAB) therapy for prostatic cancer detected from multiple lung metastases: a case report

Prostatic cancer is rarely diagnosed by detection of lung metastases. We report a case of prostatic cancer in a 73-year-old man detected by abnormalities in chest X-ray and serum prostate specific antigen (PSA) level. He was initially admitted to our hospital due to elevation of PSA level. On the first transperineal prostatic needle biopsy, prostatic cancer was not detected and he was followed. Seven months after the first biopsy, chest X-ray revealed multiple abnormal nodules in the lung fields bilaterally and PSA level was again elevated. A second prostatic biopsy and whole-body examination were performed, and he was diagnosed with moderately differentiated prostatic adenocarcinoma with multiple lung metastases. Complete androgen blockade therapy was performed immediately. Two months after the beginning of treatment, PSA level was normalized and the multiple lung metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse 24 months after detection of the prostatic cancer. This is the 26th case of prostatic cancer diagnosed in Japan following detection of multiple lung metastases.     

Invasive carcinoma of prostate presenting as rectal carcinoma

Prostate carcinoma occasionally can present with rectal obstructive symptoms and an annular constricting lesion of the rectum. Discriminating between primary rectal carcinoma and prostate carcinoma locally invasive to the rectum is of obvious importance because of the different treatments and prognoses. History and physical examination play only a marginal role in differentiating between these two lesions. The diagnosis of prostatic malignancy in patients in this circumstance can be supported by an elevated serum acid phosphatase as well as a bone scan that demonstrates a pelvic/vertebral distribution of bony metastases. The rectal mucosa is usually spared, and a barium enema often will demonstrate tapered margins as opposed to a tumor edge in primary rectal malignancy. Excretory urography often demonstrates hydronephrosis. Rectal biopsy with immunohistochemical staining for prostate specific antigen can direct the origin of a poorly differentiated adenocarcinoma to the prostate. Treatment involves hormonal manipulation with estrogen therapy or orchiectomy. Radiation therapy to the obstructed rectum has provided satisfactory palliation when hormonal manipulation fails.     

A case of primary transitional cell carcinoma of the prostate

A 77-year-old man was referred to our hospital with a complaint of dysuria and right ischiodynia. He had had a hemi-thyroidectomy for thyroid cancer and right cervical lymphadenectomy three years and one year, respectively, before this visit. Prostate cancer was strongly suspected by transrectal examination with prostate specific antigen (PSA) elevated to 77.8 ng/ml. Pathological diagnosis of prostate biopsy specimen was transitional cell carcinoma with grade 3 malignancy and negative staining for PSA. Endoscopic examination showed a normal appearance of bladder and prostatic urethral epithelium. Urine cytology showed no malignant cells. However, immunostaining for PSA revealed that the cervical lymph node specimen resected before was moderately differentiated adenocarcinoma of prostate. He had multiple metastases to mediastinal and retroperitoneal lymph nodes and right ischium. Endocrine therapy (goserelin acetate depot, bicalutamide) and systemic chemotherapy (methotrexate, epirubicin, cisplatin) were performed combined with irradiation to right ischium metastasis. Two months later, he showed a complete response in PSA and partial response in lymph node metastases, but died of cancer 13 months later.     

Detection of occult micrometastases in the bone marrow of patients with prostate carcinoma

A panel of three monoclonal antibodies that recognize membrane and cytoskeletal antigens expressed by epithelial cells (T₁₆′ C₂₆′ and AE-1) was used in a sensitive immunohistochemical assay to detect tumor cells in bone marrow aspirates from 20 patients with prostate cancer. Bone marrow aspirates from 2/9 (22%) patients with localized prostate cancer (stage B, 0/5; Stage C, 2/4), and 4/11 (36%) patients with metastatic prostate cancer (Stage D₁′ 0/7 patients; Stage D₂′ 4/4 patients) had antigen-positive cells in their bone marrow. The patients with localized disease had conventional examinations for metastases, including radioisotope bone scans and examination of bone marrow cytology, which were negative. The serum prostatic specific antigen (PSA) level appeared to correlate with the presence of micrometastases. Those patients with localized disease and antigen-positive cells in the bone marrow had an average serum PSA level of 26.6 ng/ml, while the average serum PSA level in patients without antigen-positive cells was 12.3 ng/ml. In addition, the number of antigen-positive cells detected appeared to correlate with the stage of disease; patients with Stage C prostate cancer had an average of 10 antigen-positive cells per one million bone marrow elements, while patients with Stage D2 disease had an average of 25 antigen-positive cells per one million bone marrow elements. We have demonstrated that immunohistochemical staining of bone marrow aspirates can detect occult bone marrow metastases in patients with apparently localized prostate cancer. Further follow-up of these and a larger number of patients will be required to determine the potential clinical significance of this finding. © 1994 Wiley-Liss, Inc.     

Long-term survival of stage D2 prostatic carcinoma patient treated with total cysto-prostatectomy: a case report

A 52-year-old male was admitted to this hospital as stage D2 prostatic carcinoma. He had been previously treated with transurethral resection of prostate and hormonal therapy. Rectal examination revealed the prostate bigger than a hen-egg with stony-hard nodules. Both whole body bone X-ray and bone scintigram showed multiple bone metastasis. Total cysto-prostatectomy and pelvic lymph node dissection were performed because the patient was relatively young, was in good general status and the tumor was not sensitive to hormonal therapy. In addition, he was expected to have obstructive uropathy soon and the reported results of radiotherapy for local control of advanced prostate cancer were unsatisfactory. He was followed by bone X-ray and bone scintigram every six months. Osteoplastic area diminished in size and hot lesions in bone scintigram disappeared gradually. The patient is very active in his daily life without evidence of local recurrence or new metastasis more than seven years after operation. The validity of mass reduction surgery for hormone-resistant stage D2 prostatic carcinoma is discussed.