Kise Hideaki, Shiraishi Taizo
The Department of Urology, Kuwana City Medical Center.
The Department of Pathology, Kuwana City Medical Center.
Hinyokika Kiyo. 2021 Mar;67(3):113-118. doi: 10.14989/ActaUrolJap_67_3_113.
A 56-year-old man visited our hospital with a chief complaint of worsening urinary pain after a treatment by another doctor. Prostate specific antigen (PSA) was 429.66 ng/ml, and computed tomography (CT) revealed multiple lymph node enlargement and multiple bone metastases. Prostatic adenocarcinoma (Gleason score 4＋5) was detected on the first prostate biopsy. Based on these results, the clinical stage was determined to be cT4N1M1b Androgen deprivation therapy (ADT) was started, and PSA decreased to 0.03 ng/ml at 3 months, but micturition and perineal pain tended to worsen, and multiple liver metastases were confirmed on CT. The second biopsy examination was performed and a diagnosis of neuroendocrine prostate cancer (NEPC) was made. Chemotherapy for small cell lung cancer was immediately performed, but no response was seen, and he died 8 months after the first visit. Immunostaining of prostate tissue of the first biopsy revealed that de novo NEPC expressed both PSA and synaptophysin in tumor cells.
一名56岁男性因在另一位医生处治疗后尿痛加重前来我院就诊。前列腺特异性抗原（PSA）为429.66 ng/ml，计算机断层扫描（CT）显示多发淋巴结肿大及多发骨转移。首次前列腺活检检测出前列腺腺癌（ Gleason评分4＋5）。基于这些结果，临床分期确定为cT4N1M1b，遂开始雄激素剥夺治疗（ADT），3个月时PSA降至0.03 ng/ml，但排尿及会阴疼痛趋于加重，CT证实出现多发肝转移。进行了第二次活检检查，诊断为神经内分泌前列腺癌（NEPC）。立即对小细胞肺癌进行化疗，但未见反应，患者在首次就诊8个月后死亡。首次活检的前列腺组织免疫染色显示，新发NEPC的肿瘤细胞中同时表达PSA和突触素。
