Fukuoka H, Ishibashi Y, Masuda M, Gotoh A, Murai T, Kitamura H
Department of Urology, Yokohama Minami Kyosai Hospital.
Hinyokika Kiyo. 1988 Oct;34(10):1805-9.
A 55-year-old man consulted us on December 3, 1986 with the chief complaints of left leg pain, disturbance in gait and dysuria. On digital rectal examination his prostate was found enlarged to a hen's egg size and increased in consistency. He was admitted to the hospital under the suspicion of prostatic cancer on December 8, 1986. Scout kidney-ureter-bladder X-ray revealed extensive osteolytic lesions in the left iliac and pubic bones as well as in the sacrum. Needle biopsy of the prostate demonstrated moderately differentiated adenocarcinoma, leading to a diagnosis of prostatic cancer with osteolytic bone metastases. Bone scintigraphy showed increased radioactivity uptake by the left iliac and pubic bones. Pelvic CT disclosed large tumor masses in the left ilium and sacrum, which on bone biopsy were identified as poorly differentiated adenocarcinoma. Endocrine therapy with estramustinphosphate and castration was performed along with transurethral resection of prostate. At week 16 after initiating the therapeutic regimen the patient was entirely free from disturbance in gait and the tumor mass of the left iliac bone had disappeared almost completely on the computed tomogram at week 18, although osteolytic lesions still persisted on the x-ray. This case deserves special note because endocrine therapy markedly reduced the size of the bone tumors, in spite of osteolytic bone metastases of prostatic cancer with computed tomographic evidence of large metastatic tumor masses.
一名55岁男性于1986年12月3日前来就诊，主要症状为左腿疼痛、步态障碍和排尿困难。直肠指检发现其前列腺增大至鸡蛋大小，质地变硬。1986年12月8日，他因怀疑患有前列腺癌而入院。肾脏-输尿管-膀胱X线平片显示左髂骨、耻骨及骶骨有广泛的溶骨性病变。前列腺穿刺活检显示为中度分化腺癌，诊断为前列腺癌伴溶骨性骨转移。骨闪烁显像显示左髂骨和耻骨放射性摄取增加。盆腔CT显示左髂骨和骶骨有巨大肿瘤肿块，骨活检确定为低分化腺癌。采用磷酸雌莫司汀内分泌治疗及去势治疗，并同时行经尿道前列腺切除术。在开始治疗方案后的第16周，患者步态障碍完全消失，第18周时，尽管X线片上溶骨性病变仍然存在，但计算机断层扫描显示左髂骨的肿瘤肿块几乎完全消失。该病例值得特别关注，因为尽管前列腺癌伴溶骨性骨转移且计算机断层扫描显示有巨大转移肿瘤肿块，但内分泌治疗显著缩小了骨肿瘤的大小。
