Koie Takuya, Hashimoto Yasuhiro, Suzuki Yuichiro, Hatayama Yoshiomi, Kimura Futoshi
Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
Case Rep Urol. 2020 Sep 12;2020:5627548. doi: 10.1155/2020/5627548. eCollection 2020.
A 42-year-old man visited a community hospital with chief complaints of lumbago and dyschesia. Computed tomography (CT) showed multiple lung, lymph node, and bone metastases and the irregular enlarged prostate with urinary bladder invasion. Serum prostate-specific antigen (PSA) was 544.0 ng/mL. Histological evaluation showed adenocarcinoma with the Gleason score 5 + 4, and the clinical stage was T4N1M1c as an initial diagnosis. Although androgen deprivation therapy was performed immediately, he had castration-resistant PCa after 3 months. Therefore, he received 6 courses of docetaxel chemotherapy every 3 weeks. Serum PSA was decreased to 0.2 ng/mL, and multiple metastases and prostate size were obviously reduced based on CT. He underwent robot-assisted radical prostatectomy and radiation therapy for prostatic fossa and multiple metastases. Although serum PSA level remained low, CT showed multiple liver metastases after 3 years from surgery. He received the combination therapy of cisplatin and etoposide (PE) every 4 weeks. Liver metastases had complete response. However, he visited our hospital with complaint of vomiting and a right drooping eyelid after 6 weeks from withdrawal of PE therapy. T2-weighted magnetic resonance imaging revealed multiple leptomeningeal metastases (LM). He received RT for the brain and was administered amrubicin. However, he died of PCa after 6 weeks from the diagnosis of LM.
一名42岁男性因腰痛和排尿困难为主诉就诊于社区医院。计算机断层扫描（CT）显示多发肺、淋巴结和骨转移，以及前列腺不规则增大并侵犯膀胱。血清前列腺特异性抗原（PSA）为544.0 ng/mL。组织学评估显示为 Gleason 评分5 + 4的腺癌，初始诊断临床分期为T4N1M1c。尽管立即进行了雄激素剥夺治疗，但3个月后他出现了去势抵抗性前列腺癌（PCa）。因此，他每3周接受6个疗程的多西他赛化疗。血清PSA降至0.2 ng/mL，基于CT显示多发转移灶和前列腺大小明显缩小。他接受了机器人辅助根治性前列腺切除术以及针对前列腺窝和多发转移灶的放射治疗。尽管血清PSA水平持续较低，但术后3年CT显示出现多发肝转移。他每4周接受顺铂和依托泊苷（PE）联合治疗。肝转移灶完全缓解。然而，在停用PE治疗6周后，他因呕吐和右眼睑下垂前来我院就诊。T2加权磁共振成像显示多发软脑膜转移（LM）。他接受了脑部放疗并使用了安罗替尼。然而，自LM诊断6周后，他死于PCa。
