Prostatic neuroendocrine carcinoma with priapism : a case report

An 84-year-old man presented with priapism in May, 2009. At 79 years old, he was diagnosed with stage C prostate cancer and then, was treated with hormonal therapy. The serum level of prostate-specific antigen (PSA) was within the normal range (0.02 ng/ml). Penile caverno-dorsal vein shunt (Barry shunt) and caverno-spongiosum shunt (Quackels shunt) were performed for the purpose of managing local symptoms. Following operation, the penile pain was mitigated. Postoperative computed tomography (CT) revealed the enlarged prostate and multiple metastases to lungs and multiple bone metastases. Histological examination of the prostatic needle biopsy revealed poorly differentiated neuroendocrine carcinoma of the prostate.     

A case of prostate cancer associated with osteolytic bone metastases]

It is well known that prostate cancer metastasizes bone with osteoblastic change and that osteolytic change is rare. We report a case of prostate cancer that had bone metastases which were all osteolytic. A 62-year-old man was referred to our department because of abnormal prostatic acid phosphatase and pain in his right upper arm. Digital examination revealed an enlarged and hard prostate. A computed tomographic scan revealed multiple osteolytic changes and a bone scintigraphy was positive at these sites. Histopathology of both prostate and humerus showed poorly differentiated adenocarcinoma. He received castration and antiandrogen as hormonal therapy, but the patient's prostate specific antigen did not normalize. Therefore this case was suspected to be hormone-refractory prostate cancer.     

Primary transitional cell carcinoma of the prostate presenting as a rectal ulcer

Primary transitional cell carcinoma of the prostate is a rare clinicopathological entity. It is an aggressive tumor with a poor prognosis. Presentation is usually late, with obstructive voiding complaints. Radical surgery offers locoregional control of the disease. We report a case with an atypical presentation of bleeding per rectum and associated obstructive voiding symptoms. Examination revealed a rectal ulcer overlying an enlarged prostate and fixed to it. Histopathology showed a picture of transitional cell carcinoma of the prostate infiltrating the rectum. Imaging studies revealed an enlarged prostate with altered echo pattern with locoregional spread, infiltrating the rectum. Bladder involvement and distant metastases were not evident. External beam radiotherapy achieved good local control. At 3 months of follow-up, the patient was free of urinary symptoms and his rectal ulcer had healed. The patient declined subsequent treatment.     

Bilateral breast metastases from prostatic carcinoma: a case report]

We report a case of bilateral breast metastases from prostatic carcinoma. A 49-year-old man with stage D2 prostate cancer, who had been treated by chemoendocrine therapy and radiotherapy for 2 years, complained of bilateral enlarged breasts. Oral administration of diethylstilbestrol diphosphate was started 2 months before the onset of this symptom. A firm mass that was not tender was palpable beneath the skin without fixation on each side. A needle biopsy of the masses showed poorly differentiated adenocarcinoma with positive immunohistopathological staining for prostate-specific antigen. The masses were diagnosed as metastatic adenocarcinoma of prostate gland origin. The patient died 3 months after the diagnosis of breast metastases. Autopsy revealed diffuse lymphogenous metastatic disease. Metastatic prostatic carcinoma to the breast is uncommon. Breast metastases in this patient might be associated with diffuse lymphogenous metastases as well as increased local blood and lymphatic supply caused by extrinsic estrogens.     

前列腺癌根治术后尿道多发转移1例并文献复习

目的:探讨前列腺癌根治术后尿道转移的转移机制、治疗方案。方法:总结收治的前列腺癌根治术后尿道转移1例:79岁男性,13年前因前列腺癌行前列腺癌根治术。术后予以内分泌治疗。2周前无明显诱因出现尿痛、伴肉眼血尿。尿道外口可见一1.0 cm×0.5 cm类圆形肿物。膀胱尿道镜检见尿道多发肿物,并行肿物切除活检,提示前列腺癌尿道转移。术前PSA:3.01μg/L。患者遂行尿道根治性切除术、膀胱造瘘术。结果:术后病理提示:尿道括约肌及海绵体组织中可见癌组织浸润。免疫组化:PSA(+),PsAP(+),AR(+),CK7(-),考虑为前列腺癌。手术切缘未见肿瘤。术后恢复良好,术后PSA:1.00μg/L。结论:前列腺癌根治术后尿道转移临床罕见,外科手术为首选的治疗方案,适当的根治性切除手术应该是有效的治疗方式。     

Prostate cancer in a young adult : a case report

We report a case of prostate cancer in a 41-year-old male. The patient initially visited another institution with a chief complaint of left breech pain. He was referred to our hospital for further investigation. Serum level of PSA was 267ng/ml and multiple bone metastases were found on bone scintigram. Digital rectal examination revealed a stony-hard prostate. Computed tomography showed multiple lung and lymph node metastases. Transperineal needle biopsy of the prostate revealed moderately differentiated adenocarcinoma (Gleason score 4＋5) frombilateral lobes (the 3th Edition). The patient was diagnosed with cT4N1M1c prostate cancer and maximal androgen blockade therapy was commenced.     

Successful therapy of a malignant phyllodes tumor of the prostate after postoperative local failure

A 19-year-old student who had presented with acute urinary retention was referred to our hospital with biopsy diagnosis of proliferating mesenchymal tumor of the prostate. Magnetic resonance imaging showed enlarged prostatic masses. Suspecting prostate sarcoma, we performed a nerve-sparing radical prostatectomy. Histologic diagnosis of the tumor was prostatic malignant phyllodes tumor. Five months after the operation, bilateral obturator lymph node metastases appeared, which were treated with etoposide, ifosfamide, and cisplatin chemotherapy. After a good response was achieved with four cycles of the chemotherapy, pelvic irradiation was added. Since then, there has been no evidence of recurrence for more than 4 years.     

Metastatic basal cell carcinoma of prostate in a young adult: A rare aggressive entity

Introduction

Prostate cancer is one of the commonest, malignancies affecting elderly males. Prostatic basal cell carcinoma, (PBCC) accounts for less than 0.01% of all prostate cancers.

Mucinous adenocarcinoma of the prostate with good response to hormonal therapy: a case report]

A 79-year-old man complained of pollakisuria and sense of retention. The prostate was stony hard and heterogeneously enhanced on computed tomographic (CT) scan. The serum levels of prostatic specific antigen, prostatic acid phosphatase and gamma-Seminoprotein were abnormally high. Prostatic biopsy showed mucinous adenocarcinoma which was stained by prostatic specific antigen. Bone scintigraphy revealed multiple metastases. Hormonal therapy was performed. Each prostatic tumor marker decreased to the normal range within 2 months. After 3 months, the prostate was almost normalized on digital examination and CT scan. There were no new metastases, prostatic biopsy revealed that most cancer cells had degenerated to nonviable cells and bone metastases had decreased.     

Carcinosarcoma of the prostate.

A very rare case of carcinosarcoma of the prostate is reported. The patient was a 77-year-old man in whom both primary and metastatic tumors presented the pathology of carcinosarcoma of the prostate. The carcinosarcoma was resistant to anti-androgen therapy, and the patient showed low level of serum prostatic acid phosphatase and was free from bony metastases despite multiple metastases to the lung, liver, pancreas, para-aortic lymph nodes, spleen and penis. The sarcomatous component consisted of chondrosarcoma and fibrosarcoma, both of which were positive for vimentin. The carcinomatous component was positive for both keratin and prostatic acid phosphatase.     

Small cell carcinoma of the prostate: an autopsy case report

An 83-year-old man was admitted to our hospital with complaints of dysuria and backache. The patient had been treated with a luteinizing hormone-releasing hormone analogue for 2 years. An enlarged, hard and nodular prostate was palpable on digital rectal examination. Serum level of prostate specific antigen (PSA) was 1.7 ng/ml (0-4) and that of neuron-specific enolase (NSE) were 263.2 ng/ml (0-10). Multiple bone and liver metastases were seen on CT and MRI. After hospitalization, the liver function worsened markedly. The patient died on the 34th hospital day, and was diagnosed with primary small cell carcinoma of prostate on autopsy.     

Cranial nerve palsies due to skull base metastases in patients with prostate cancer: a report of two cases

Two patients with prostate cancer showed cranial nerve palsies due to skull base metastases. Case 1: A 64-year-old man had prostate cancer (T4 N0 M1, Gleason score 7, prostate-specific antigen [PSA] level 372 ng/mL) with multiple bone metastases. Seventy-seven months after initiation of therapy, he had an articulation disorder and palsy of the left side of the tongue, with 12th cranial nerve palsy. Case 2: A 75-year-old man had a prostate cancer (T3b N0 M1, Gleason score 7, PSA level 177 ng/mL) with multiple bone metastases. Sixty-six months after initiation of therapy, he had hearing loss, noise in the right ear, and dizziness, with 8th cranial nerve deficits. Magnetic resonance imaging showed low intensity in the clivus in both cases, and all over the skull in case 2. The first patient was treated with radiation therapy and intravenous steroids at an early date. His symptoms improved.     

Small cell carcinoma of the prostate successfully treated with combined chemotherapy and radiotherapy: a case report

A 49-year-old man complained of dysuria and pollakisuria. The prostate was enlarged, and the serum level of prostate specific antigen was within the normal range. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of the prostate was performed. Unexpectedly, histopathological examination of the resected tissues revealed pure small cell carcinoma. The serum level of progastrin-releasing peptide (ProGRP) was slightly elevated. The cancer was clinically diagnosed as stage C. Pelvic radiotherapy combined with chemotherapy using cisplatin (CDDP) and etoposide (VP-16) was started according to the treatment for limited small cell cancer of the lung. After one month, the serum level of ProGRP decreased to the normal range. After four months, the prostate was reduced in size without any findings of metastases on computed tomography, and prostate biopsy revealed no viable cancer cells.     

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.     

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.     

A case of prostatic carcinoma with osteolytic bone metastases

A 55-year-old man consulted us on December 3, 1986 with the chief complaints of left leg pain, disturbance in gait and dysuria. On digital rectal examination his prostate was found enlarged to a hen's egg size and increased in consistency. He was admitted to the hospital under the suspicion of prostatic cancer on December 8, 1986. Scout kidney-ureter-bladder X-ray revealed extensive osteolytic lesions in the left iliac and pubic bones as well as in the sacrum. Needle biopsy of the prostate demonstrated moderately differentiated adenocarcinoma, leading to a diagnosis of prostatic cancer with osteolytic bone metastases. Bone scintigraphy showed increased radioactivity uptake by the left iliac and pubic bones. Pelvic CT disclosed large tumor masses in the left ilium and sacrum, which on bone biopsy were identified as poorly differentiated adenocarcinoma. Endocrine therapy with estramustinphosphate and castration was performed along with transurethral resection of prostate. At week 16 after initiating the therapeutic regimen the patient was entirely free from disturbance in gait and the tumor mass of the left iliac bone had disappeared almost completely on the computed tomogram at week 18, although osteolytic lesions still persisted on the x-ray. This case deserves special note because endocrine therapy markedly reduced the size of the bone tumors, in spite of osteolytic bone metastases of prostatic cancer with computed tomographic evidence of large metastatic tumor masses.     

A case of Collet-Sicard syndrome caused by skull base metastasis of prostate carcinoma

A case of Collet-Sicard Syndrome caused by skull base metastasis of prostate carcinoma is reported. A fifty-five years old man presenting multiple lymph node and bone metastases of prostate carcinoma was treated with LH-RH agonist and Flutamide, which induced transient decrease in serum PSA levels and size of lymph node metastases. After 8 months of the treatment, the patient started complaining headache, dysphagia and dysarthria. Brain CT and MRI demonstrated a soft tissue mass replacing left pyramidal bone and occipital bone around left jugular foramen. The tumor was diagnosed as skull base metastasis of the prostate carcinoma and was treated with 50Gy of radiation. The symptom improved after the radiation but died of the disease in 4 months. The autopsy revealed the skull base metastasis of the prostate carcinoma and the tumor was proved to be poorly differentiated adenocarcinoma, which was positively stained by anti-PSA antibody. The case showed cranial nerve palsy of IX to XII, which is usually called Collet-Sicard syndrome. This is the third case report of Collet-Sicard syndrome caused by the skull base metastasis of prostate carcinoma, and it is the first case in Japan.     

Gastrointestinal stromal tumor of the prostate

We present a unique case of an atypical prostate tumor in a 49-year-old man with acute urinary retention. Digital rectal examination revealed a large prostate with a parenchymal mass on the left side. Radiologic imaging showed a 14.2 x 9.6 x 14.0-cm prostatic mass and multiple liver metastases. A pathologic diagnosis of a prostatic gastrointestinal stromal tumor was made and was confirmed by molecular analysis. Therapy consisted of a tyrosine kinase inhibitor, resulting in prostate mass reduction. After 100 weeks, the patient was in good physical condition with a continuing partial response with a reduced mass volume and liver nodules.     

Complete remission of brain metastases from prostate cancer by gamma knife radiosurgery: a case report]

A 59-year-old male visited us with a chief complaint of dysuria. The serum prostate specific antigen (PSA) level was within normal limits, and intravenous pyelography and urethrocystography showed no abnormal findings. Because of his urinary retention, transurethral resection of prostate was performed under a clinical diagnosis of benign prostatic hyperplasia. The pathological diagnosis was poorly differentiated adenocarcinoma of the prostate. Not only combination hormone therapy with goserelin acetate and flutamide, but also intermittent arterial infusion chemotherapy with cisplatin (CDDP) and pirarubicin (THP) using a reservoir system was administered. Additionally total pelvic irradiation was delivered. Magnetic resonance imaging (MRI) demonstrated that his prostate was reduced to less than 50% in size and he had no difficulty in voiding. He suddenly developed dysarthria and hemiplegia 3 months later. MRI and computed tomography (CT) revealed multiple brain metastases. After the gamma knife radiosurgery, neurological findings disappeared and MRI showed dramatic shrinkage of metastatic brain tumors. Metastasis to the pancreas was recognized on CT and he died of multiple organ failure 30 months after his first visit.     

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.