Nagayoshi J, Higashi T, Maruyama Y
Department of Urology, Matsusaka Chuo Hospital.
Hinyokika Kiyo. 1999 Aug;45(8):543-6.
A 72-year-old man presented with pollakiuria and dysuria. His prostate was the size of an apple and hard on digital rectal examination and the serum prostate specific antigen (PSA) level was 73 ng/ml (RIA). Ultrasonography revealed bilateral hydronephrosis and the serum creatinine level was 13.2 mg/dl. CT scanning of the abdomen demonstrated swelling of paraaortic lymph nodes. Transrectal needle biopsy of the prostate gave a diagnosis of moderately differentiated adenocarcinoma. Accordingly, the final diagnosis was prostate cancer (cT3N4M1, stage D2). Immediately after bilateral percutaneous nephrostomy, treatment with an LH-RH agonist (goserelin) and flutamide was commenced. Serum creatinine was 6.6 mg/dl at the start of antiandrogen therapy and decreased to 1.8 mg/dl after 27 days. A 125 mg flutamide capsule was administered at 7 a.m., and blood samples were collected 4 hours later on days 1, 2, 3, 5, 6, 8, 12, 14, 17, 18 and 27. The OH-flutamide concentration was measured. There was no significant correlation between serum creatinine and the OH-flutamide concentration. After implantation of goserelin (3.6 mg depot), blood samples were obtained at 11 a.m. on days 8, 12, 14, 15 and 25. The serum goserelin level was measured. The serum goserelin level increased to a peak on day 14, as described previously, but the peak value of 9.63 ng/ml was higher than that reported before (mean +/- SD 2.848 +/- 0.199).
一名72岁男性因尿频和排尿困难前来就诊。他的前列腺如苹果般大小，直肠指检时质地坚硬，血清前列腺特异性抗原（PSA）水平为73 ng/ml（放射免疫分析法）。超声检查显示双侧肾积水，血清肌酐水平为13.2 mg/dl。腹部CT扫描显示腹主动脉旁淋巴结肿大。经直肠前列腺穿刺活检诊断为中度分化腺癌。因此，最终诊断为前列腺癌（cT3N4M1，D2期）。在双侧经皮肾造瘘术后，立即开始使用促性腺激素释放激素（LH-RH）激动剂（戈舍瑞林）和氟他胺进行治疗。抗雄激素治疗开始时血清肌酐为6.6 mg/dl，27天后降至1.8 mg/dl。每天上午7点服用125 mg氟他胺胶囊，并在第1、2、3、5、6、8、12、14、17、18和27天4小时后采集血样，测定羟基氟他胺浓度。血清肌酐与羟基氟他胺浓度之间无显著相关性。在植入戈舍瑞林（3.6 mg长效制剂）后，于第8、12、14、15和25天上午11点采集血样，测定血清戈舍瑞林水平。血清戈舍瑞林水平在第14天升至峰值，如先前所述，但9.63 ng/ml的峰值高于之前报道的值（均值±标准差为2.848±0.199）。
