Guthman D A, Farrow G M, Myers R P, Ferrigni R G, Lieber M M
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1991 Sep;146(3):854-6. doi: 10.1016/s0022-5347(17)37943-0.
Of 3 patients with clinically localized adenocarcinoma of the prostate 2 were treated by radical prostatectomy and 1 was treated with radiation therapy. Serum prostate specific antigen (PSA) values were elevated before therapy. After treatment the PSA levels were decreased to zero. All 3 patients later had evidence of metastatic tumor spread to the liver with elevation of serum carcinoembryonic antigen but not PSA. Immunohistochemical staining of the 2 primary tumors from the prostatectomy specimens identified 2 cell clones, one immunoreactive to PSA and prostatic acid phosphatase (PAP) and nonimmunoreactive to carcinoembryonic antigen, and the other immunoreactive to carcinoembryonic antigen but not PSA or PAP. Biopsy of a hepatic metastasis in 2 patients confirmed anaplastic carcinoma of the carcinoembryonic antigen-producing cell type. Immunohistochemical staining of a lymph node metastasis identified the PSA-producing cell type only. Such results suggest selective metastatic spread of each cell type to its own organ tropic site. Occasional carcinoembryonic antigen-producing prostate cancers may metastasize to the liver. Serum carcinoembryonic antigen measurements occasionally may be useful in the management of certain prostate adenocarcinoma patients.
在3例临床局限性前列腺腺癌患者中，2例行根治性前列腺切除术，1例行放射治疗。治疗前血清前列腺特异性抗原（PSA）值升高。治疗后PSA水平降至零。所有3例患者后来均有肿瘤转移至肝脏的证据，血清癌胚抗原升高，但PSA未升高。对前列腺切除标本中的2个原发性肿瘤进行免疫组织化学染色，鉴定出2个细胞克隆，一个对PSA和前列腺酸性磷酸酶（PAP）呈免疫反应，对癌胚抗原不呈免疫反应，另一个对癌胚抗原呈免疫反应，但对PSA或PAP不呈免疫反应。对2例患者的肝转移灶进行活检，证实为产生癌胚抗原的细胞类型的间变性癌。对1例淋巴结转移灶进行免疫组织化学染色，仅鉴定出产生PSA的细胞类型。这些结果提示每种细胞类型选择性转移至其自身的器官靶向部位。偶尔，产生癌胚抗原的前列腺癌可能转移至肝脏。血清癌胚抗原检测偶尔可能对某些前列腺腺癌患者的管理有用。
