Martínez-Cornelio Andrés, González-Pérez Juventino, Tabares-García Felipe de Jesús, Ramos-Salgado Francisco, Alvarado-Cabrero Isabel, Hernández-Toriz Narciso
Servicio de Urología Oncológica, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., Mexico.
Cir Cir. 2009 Jul-Aug;77(4):293-9; 273-8.
Prostatic neuroendocrine carcinomas comprise <1% of all prostate neoplasms, and approximately 200 cases have been reported in the literature. We undertook this study to describe the experience in the management of prostatic neuroendocrine carcinoma with androgen-deprivation therapy (ADT).
We designed a retrospective, descriptive and observational study. In patients with suspicion of prostate cancer, transrectal ultrasonography-guided biopsy (TRUS) or transurethral resection of prostate (TURP) was carried out during the period from January 2000 to December 2007. Patients were selected by anatomopathological diagnostic study of neuroendocrine carcinoma including pure and mixed variants. Characteristics analyzed were age, clinical stage, prostate-specific antigen (PSA), imaging studies, treatment and survival.
Ten cases were included with a median age of 66.5 years. Symptoms at diagnosis were associated with metastasis to other organs, one with bone metastasis, and presenting pain in 100% of the cases. A suspicious rectal digital examination was detected in 100% of the patients. In three (30%) patients, PSA was suspicious for prostate cancer. The extension studies showed bone, locoregional, lung and hepatic metastases. In six (60%) patients mixed variant was documented (acinar adenocarcinoma and neuroendocrine carcinoma) with a median survival of 11.6 months. In four patients (40%), pure neuroendocrine carcinoma was documented with a median survival of 7 months.
Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.
前列腺神经内分泌癌占所有前列腺肿瘤的比例不到1%，文献报道约200例。我们开展本研究以描述雄激素剥夺治疗（ADT）在前列腺神经内分泌癌管理中的经验。
我们设计了一项回顾性、描述性和观察性研究。在2000年1月至2007年12月期间，对疑似前列腺癌的患者进行经直肠超声引导下活检（TRUS）或经尿道前列腺切除术（TURP）。通过对包括纯合和混合变体在内的神经内分泌癌进行解剖病理学诊断研究来选择患者。分析的特征包括年龄、临床分期、前列腺特异性抗原（PSA）、影像学检查、治疗和生存情况。
纳入10例患者，中位年龄为66.5岁。诊断时的症状与转移至其他器官有关，1例有骨转移，所有病例均有疼痛。100%的患者直肠指检可疑。3例（30%）患者的PSA可疑为前列腺癌。扩展研究显示有骨、局部、肺和肝转移。6例（60%）患者记录为混合变体（腺泡腺癌和神经内分泌癌），中位生存期为11.6个月。4例（40%）患者记录为纯神经内分泌癌，中位生存期为7个月。
前列腺神经内分泌癌不常见、侵袭性强，是一种无PSA表达的前列腺肿瘤。在晚期疾病中，ADT的反应非常低。
