Fujita Masahiro, Goto Takayasu, Uchida Kinya, Saiki Shigeru, Arima Ryoichi
The Department of Urology, Federation of National Public Service and Affiliated Personnel Mutual Aid Association Otemae Hospital.
Hinyokika Kiyo. 2013 Mar;59(3):183-8.
A 63-year-old man was hospitalized with an increased serum prostate specific antigen (PSA) level (72 ng/ml). A prostate biopsy was performed, and histological examinations indicated moderately and poorly differentiated adenocarcinoma with positive staining for carcinoembryonic antigen (CEA). The patient was diagnosed as having prostate cancer (clinical stage : T3bN0M0) and received radiotherapy and hormonal therapy. Five years after the diagnosis, the serum CEA level increased to 153.8 ng/dl, and the patient complained of abdominal pain. His serum PSA level remained normal (<0.1 ng/dl). Computed topography indicated multiple bone metastasis and the involvement of multiple lymph glands. A biopsy of a cervical lymph gland revealed poorly differentiated adenocarcinoma with positive staining for CEA. Gastrointestinal examination showed no evidence of abnormality. The diagnosis of metastatic prostate cancer was made, and docetaxel (60-70 mg/m2) was administered. Eight courses of docetaxel therapy led to an approximately 20% reduction in lymph volume, and the serum CEA level decreased. However, liver metastases developed 12 months later, and the patient died at 18 months after the diagnosis of metastatic prostate cancer with a high serum CEA level. We encountered a case of recrudescence of prostate cancer positive for CEA with a low serum PSA level and report the effect of docetaxel therapy for atypical prostatic carcinoma.
一名63岁男性因血清前列腺特异性抗原（PSA）水平升高（72 ng/ml）入院。进行了前列腺活检，组织学检查显示为中低分化腺癌，癌胚抗原（CEA）染色呈阳性。该患者被诊断为前列腺癌（临床分期：T3bN0M0），并接受了放疗和激素治疗。诊断后五年，血清CEA水平升至153.8 ng/dl，患者主诉腹痛。其血清PSA水平仍正常（<0.1 ng/dl）。计算机断层扫描显示多处骨转移及多个淋巴结受累。颈部淋巴结活检显示为低分化腺癌，CEA染色呈阳性。胃肠道检查未发现异常。诊断为转移性前列腺癌，给予多西他赛（60 - 70 mg/m²）治疗。八个疗程的多西他赛治疗使淋巴结体积减少了约20%，血清CEA水平下降。然而，12个月后出现肝转移，患者在诊断为转移性前列腺癌且血清CEA水平高18个月后死亡。我们遇到了一例血清PSA水平低但CEA阳性的前列腺癌复发病例，并报告了多西他赛治疗非典型前列腺癌的效果。
