Matsuyama Nayuka, Naiki Taku, Naiki-Ito Aya, Chaya Ryosuke, Kawai Tatsuya, Etani Toshiki, Nagai Takashi, Kato Hiroyuki, Kubota Yasue, Yasui Takahiro
Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan.
Department of Experimental Pathology and Tumor Biology Graduate School of Medical Sciences Nagoya City University Nagoya Japan.
IJU Case Rep. 2020 Nov 30;4(1):59-63. doi: 10.1002/iju5.12241. eCollection 2021 Jan.
The prognosis of cancer of unknown primary is very poor. Such a prognosis can be improved by characterizing primary characteristics and developing tailored site-specific therapy, especially for androgen receptor-positive adenocarcinoma. However, in such cases without elevated prostate-specific antigen, the efficacy of androgen deprivation therapy is unclear.
Herein, we report a case that presented with a retroperitoneal cancer of unknown primary that was confirmed as an androgen receptor-positive adenocarcinoma without prostate-specific antigen elevation. Pelvic magnetic resonance imaging did not reveal any suspicious cancer lesions in the prostate. Furthermore, malignant cells were not present in a prostate biopsy specimen. In spite of the prostate-specific antigen level, on the basis of immunohistochemical analyses, including NKX3.1, the patient was first treated with androgen deprivation therapy, leading to long-term progression-free survival.
Early androgen deprivation therapy based on immunohistochemical analyses might lead to a good outcome in androgen receptor-positive adenocarcinoma cancer of unknown primary patients regardless of prostate-specific antigen level.
原发灶不明的癌症预后很差。通过明确原发灶特征并制定针对性的局部治疗方案，尤其是对于雄激素受体阳性腺癌，可改善这种预后。然而，在前列腺特异性抗原未升高的此类病例中，雄激素剥夺治疗的疗效尚不清楚。
在此，我们报告一例患者，其表现为原发灶不明的腹膜后癌，经证实为雄激素受体阳性腺癌且前列腺特异性抗原未升高。盆腔磁共振成像未发现前列腺有任何可疑癌灶。此外，前列腺活检标本中未发现恶性细胞。尽管前列腺特异性抗原水平如此，但基于包括NKX3.1在内的免疫组化分析，该患者首先接受了雄激素剥夺治疗，并实现了长期无进展生存。
基于免疫组化分析的早期雄激素剥夺治疗可能使原发灶不明的雄激素受体阳性腺癌患者获得良好预后，而不受前列腺特异性抗原水平的影响。
