Flitsch Jörg, Bernreuther Christian, Hagel Christian, Lüdecke Dieter K
Pituitary Unit, Department of Neurosurgery, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Neurosurg. 2008 Oct;109(4):760-4. doi: 10.3171/JNS/2008/109/10/0760.
The growth of prostate cancer is controlled by several hormones and growth factors. In cases of metastasized prostate cancer, antigonadotropic therapy is currently considered state-of-the-art treatment. Surgical therapies such as adrenalectomy and hypophysectomy are no longer in use. Nevertheless, hypophysectomy has proven efficacy for palliative pain treatment as well as increasing duration of survival. The authors present the case of a 63-year-old man with metastatic prostate cancer who presented with high serum prostate-specific antigen levels (1216 microg/L) and cavernous sinus syndrome. His disease was progressing despite leuprorelin and docetaxel therapy, and he had severe bone pain despite high-dose pain therapy. He was also anemic. Contrast-enhanced MR imaging showed a pituitary lesion as well as metastatic infiltration of the skull base including the cavernous sinus. The patient's serum level of prolactin was mildly elevated, testosterone was below the detection limit, and insulin-like growth factor-I (IGF-I) was in the upper range for a patient of his age (233 microg/L). Because of the elevated prolactin and high-normal IGF-I levels he was offered a hypophysectomy in addition to pituitary tumor removal. Histological examination of the resected lesion confirmed a nonsecreting pituitary adenoma with infiltration of prostate cancer cells. Postoperatively the patient's prostate-specific antigen levels dropped to 876 microg/L, his bone pain resolved, and the cavernous sinus syndrome improved. Nevertheless, he died of septicemia 4 months after surgery. Older publications as well as this case have shown the benefit of hypophysectomy for pain treatment. A reduction of IGF-I levels even in the final stage metastasized prostate cancer may play a major role. Respectively, clinical studies with somatostatin analogs are currently in progress, which may lead to a "new" way of treatment in these otherwise hopeless patients. On the basis of the pain relief seen after hypophysectomy in this case and similar benefits reported in older publications, the authors raise the question whether this treatment should be offered more frequently, and whether additional medical options of hormone treatment may be beneficial in similar cases.
前列腺癌的生长受多种激素和生长因子控制。在转移性前列腺癌病例中，促性腺激素释放激素类似物疗法目前被视为标准治疗方法。诸如肾上腺切除术和垂体切除术等手术疗法已不再使用。然而，垂体切除术已被证明对缓解疼痛以及延长生存期有效。作者报告了一例63岁转移性前列腺癌男性患者，其血清前列腺特异性抗原水平较高（1216μg/L）且伴有海绵窦综合征。尽管接受了亮丙瑞林和多西他赛治疗，其病情仍在进展，尽管接受了大剂量止痛治疗，他仍有严重的骨痛。他还患有贫血。增强磁共振成像显示垂体有病变以及包括海绵窦在内的颅底转移性浸润。患者血清催乳素水平轻度升高，睾酮低于检测限，胰岛素样生长因子-I（IGF-I）处于其年龄患者的较高范围（233μg/L）。由于催乳素升高和IGF-I水平处于高正常范围，除了切除垂体肿瘤外，还为他实施了垂体切除术。对切除病变的组织学检查证实为非分泌性垂体腺瘤伴前列腺癌细胞浸润。术后患者的前列腺特异性抗原水平降至876μg/L，骨痛缓解，海绵窦综合征改善。然而，他在术后4个月死于败血症。既往文献以及该病例均显示垂体切除术对疼痛治疗有益。即使在转移性前列腺癌晚期，IGF-I水平的降低可能也起主要作用。相应地，目前正在进行生长抑素类似物的临床研究，这可能为这些原本绝望的患者带来“新”的治疗方法。基于该病例垂体切除术后出现的疼痛缓解以及既往文献报道的类似益处，作者提出疑问，这种治疗是否应更频繁地提供，以及在类似病例中额外的激素治疗医学选择是否可能有益。
