Department of Urology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
Int J Clin Oncol. 2010 Feb;15(1):109-11. doi: 10.1007/s10147-009-0006-4. Epub 2010 Jan 20.
We performed transurethral resection of the prostate (TUR-P) for a 66-year-old man with benign prostatic hyperplasia. Pathological examination diagnosed poorly differentiated urothelial carcinoma of the urethra with broad prostatic permeation. Random bladder biopsies showed no malignancy, but a second TUR-P revealed urothelial carcinoma in the prostate and bladder neck. Computed tomography (CT) showed lymph node metastases from para-aortic to right/left external iliac and left obturator nodes, so clinical stage T3N2M0 carcinoma of the prostatic urethra was diagnosed. Given the presence of lymph node metastases, neoadjuvant chemotherapy using cisplatin 70 mg/m(2), ifosfamide 1.2 g/m(2) and docetaxel 70 mg/m(2) (PIT) was considered. After chemotherapy, CT showed complete response (CR) of all lymph nodes. Local control in the bladder was considered to be good, so total prostatectomy and retroperitoneal lymph node dissection was selected instead of total cystoprostatectomy. Pathological findings of surgical specimens showed no residual carcinoma in the prostatic urethra or lymph nodes, although prostatic adenocarcinoma was recognized. No recurrences or metastases have been encountered as of 3 years and 5 months since surgery.
我们为一位 66 岁的良性前列腺增生患者施行经尿道前列腺切除术（TUR-P）。病理检查诊断为尿道广泛前列腺浸润的低分化尿路上皮癌。随机膀胱活检未发现恶性肿瘤，但第二次 TUR-P 显示前列腺和膀胱颈部存在尿路上皮癌。计算机断层扫描（CT）显示从主动脉旁到右/左髂外和左闭孔淋巴结的淋巴结转移，因此诊断为前列腺尿道的临床分期 T3N2M0 癌。鉴于存在淋巴结转移，考虑使用顺铂 70mg/m²、异环磷酰胺 1.2g/m² 和多西他赛 70mg/m²（PIT）进行新辅助化疗。化疗后，CT 显示所有淋巴结完全缓解（CR）。膀胱局部控制被认为良好，因此选择了前列腺全切术和腹膜后淋巴结清扫术，而不是全膀胱前列腺切除术。手术标本的病理检查结果显示，前列腺尿道或淋巴结均无残留癌，但发现前列腺腺癌。自手术以来 3 年零 5 个月，未出现复发或转移。
