Cui Yankang, Miao Chenkui, Xu Aiming, Wang Zengjun, Liu Bianjiang
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ann Palliat Med. 2021 Feb;10(2):2366-2370. doi: 10.21037/apm-20-386. Epub 2020 Jun 23.
Acinar adenocarcinoma, ductal adenocarcinoma and mucinous adenocarcinoma are the subtypes of prostate cancer (PCa). Most of the pathological types of PCa are acinar adenocarcinoma, while ductal adenocarcinoma and mucinous adenocarcinoma are uncommon. The case of acinar adenocarcinoma with ductal and mucinous adenocarcinoma has not been reported before. Herein, we report a treatment experience involving a 72-year-old man who presented similarly as most PCa patients, but the pathologic diagnosis was acinar adenocarcinoma with focal ductal and mucinous adenocarcinoma differentiating. Besides, this case is associated with lung metastasis, after radical prostatectomy (RP) and endocrine therapy the pulmonary nodule exerted a shrinking trend and the PSA level of this patient is still maintained at 0 ng/ mL till now. Through literature review, we found that patients who diagnosed as mixed pathological type of PCa had a lower survivor than pure PCa patients. Furthermore, there is no corresponding consensus or guideline for treating such multiple differentiated PCa patients. Surprisingly, this patient showed a high sensitivity to androgen deprivation therapy (ADT). Although the tumor presented aggressiveness, the followup results were satisfactory and we will continue to pay attention to his physical condition. We report this case to provide a treatment strategy for the patients with multi-differentiated PCa complicated with organ metastases.
腺泡腺癌、导管腺癌和黏液腺癌是前列腺癌（PCa）的亚型。PCa的病理类型大多为腺泡腺癌，而导管腺癌和黏液腺癌并不常见。此前尚未有腺泡腺癌合并导管和黏液腺癌的病例报道。在此，我们报告一例72岁男性的治疗经历，该患者临床表现与大多数PCa患者相似，但病理诊断为腺泡腺癌伴局灶性导管和黏液腺癌分化。此外，该病例伴有肺转移，在根治性前列腺切除术（RP）和内分泌治疗后，肺结节呈缩小趋势，该患者的前列腺特异性抗原（PSA）水平至今仍维持在0 ng/mL。通过文献回顾，我们发现诊断为PCa混合病理类型的患者生存率低于单纯PCa患者。此外，对于治疗这类多分化PCa患者尚无相应的共识或指南。令人惊讶的是，该患者对雄激素剥夺治疗（ADT）表现出高敏感性。尽管肿瘤具有侵袭性，但随访结果令人满意，我们将继续关注他的身体状况。我们报告此病例，旨在为多分化PCa合并器官转移的患者提供一种治疗策略。
