Autio Karen, McBride Sean
Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Immunother Precis Oncol. 2022 Jun 15;5(3):79-83. doi: 10.36401/JIPO-22-4. eCollection 2022 Aug.
Transformation to squamous cell carcinoma (SCC) after initial treatment of a primary prostate adenocarcinoma is rare and typically results in rapid treatment-refractory disease progression and death. Here, we present a case of a 70-year-old man who was initially treated with prostatectomy and radiotherapy, and later developed bone metastases. After commencing systemic therapy with androgen deprivation therapy (ADT) and apalutamide, his prostate-specific antigen (PSA) declined to undetectable levels, yet short-interval imaging demonstrated oligo-progression at T4, with biopsy specimen demonstrating pure SCC. Molecular profiling of both the primary prostate tumor and T4 demonstrated alterations in , , and confirming site of origin, with loss of in the squamous metastasis. He was treated with stereotactic body radiation therapy to the SCC metastasis and continued on ADT and apalutamide with stable disease for a year post-radiation. This case highlights the importance of imaging to detect non-PSA-producing metastatic disease, the utility of radiation therapy in oligo-progression, and use of molecular profiling to provide insights into the pathogenesis of histologic transformation.
原发性前列腺腺癌初始治疗后转化为鳞状细胞癌（SCC）的情况罕见，通常会导致疾病迅速进展且对治疗难治，最终死亡。在此，我们报告一例70岁男性病例，该患者最初接受了前列腺切除术和放射治疗，后来出现骨转移。在开始使用雄激素剥夺疗法（ADT）和阿帕鲁胺进行全身治疗后，他的前列腺特异性抗原（PSA）降至无法检测的水平，但短间隔成像显示T4处寡进展，活检标本显示为纯SCC。对原发性前列腺肿瘤和T4进行的分子分析显示， 、 和 发生改变，证实了起源部位，鳞状转移灶中 缺失。他接受了针对SCC转移灶的立体定向体部放射治疗，并继续接受ADT和阿帕鲁胺治疗，放疗后疾病稳定一年。该病例突出了成像检测非PSA产生性转移性疾病的重要性、放射治疗在寡进展中的效用以及使用分子分析深入了解组织学转化发病机制的作用。
