Li Ke-Hao, Du Yuan-Cheng, Yang Dong-Yu, Yu Xin-Yuan, Zhang Xue-Ping, Li Yong-Xiang, Qiao Liang
Department of Clinic, Weifang Medical University, Weifang 261000, Shandong Province, China.
Department of Urology, Weifang People's Hospital, Weifang 261000, Shandong Province, China.
World J Clin Cases. 2022 May 26;10(15):4985-4990. doi: 10.12998/wjcc.v10.i15.4985.
The 2020 European Association of Urology prostate cancer guidelines recommend androgen deprivation therapy (ADT) in combination with apalutamide and enzalutamide, a new generation of androgen receptor antagonists, as first-line therapy. A decrease in prostate-specific antigen (PSA) levels may occur in the early stages of novel hormonal therapy; however, radionuclide bone imaging may suggest disease progression. During follow-up, PSA, radionuclide bone imaging, and prostate-specific membrane antigen (PSMA) positron emission tomography - computed tomography (PET-CT) are needed for systematic evaluation.
We admitted a 56-year-old male patient with metastatic hormone-sensitive prostate cancer. Initial radionuclide bone imaging, magnetic resonance imaging (MRI), and PSMA PET-CT showed prostate cancer with multiple bone metastases. Ultrasound-guided needle biopsy of the prostate revealed a poorly differentiated adenocarcinoma of the prostate with a Gleason score: 5+4 = 9. The final diagnosis was a prostate adenocarcinoma (TNM). ADT with novel hormonal therapy (goseraline sustained-release implant 3.6 mg monthly and apalutamide 240 mg daily) was commenced. Three months later, radionuclide bone imaging and MRI revealed advanced bone metastasis. However, PSMA PET-CT examination showed a significant reduction in PSMA aggregation on the bone, indicating improved bone metastases. Considering that progressive decrease in the presenting lumbar pain, treatment strategies were considered to be effective.
ADT using novel hormonal therapy is effective for treating patients with prostate adenocarcinoma. Careful evaluation must precede treatment plan changes.
2020年欧洲泌尿外科学会前列腺癌指南推荐将雄激素剥夺疗法（ADT）与新一代雄激素受体拮抗剂阿帕他胺和恩杂鲁胺联合使用作为一线治疗方案。在新型激素治疗的早期阶段，前列腺特异性抗原（PSA）水平可能会下降；然而，放射性核素骨显像可能提示疾病进展。在随访期间，需要进行PSA、放射性核素骨显像和前列腺特异性膜抗原（PSMA）正电子发射断层扫描-计算机断层扫描（PET-CT）以进行系统评估。
我们收治了一名56岁的转移性激素敏感性前列腺癌男性患者。初始放射性核素骨显像、磁共振成像（MRI）和PSMA PET-CT显示前列腺癌伴多发骨转移。前列腺超声引导下穿刺活检显示为低分化前列腺腺癌，Gleason评分：5+4 = 9。最终诊断为前列腺腺癌（TNM）。开始采用新型激素疗法进行ADT（每月使用戈舍瑞林缓释植入剂3.6 mg和每日使用阿帕他胺240 mg）。三个月后，放射性核素骨显像和MRI显示骨转移进展。然而，PSMA PET-CT检查显示骨上的PSMA聚集显著减少，表明骨转移有所改善。考虑到现有的腰痛逐渐减轻，认为治疗策略有效。
采用新型激素疗法的ADT对治疗前列腺腺癌患者有效。在改变治疗方案之前必须进行仔细评估。
