前列腺导管腺癌一例报告并文献复习

Ductal adenocarcinoma of the prostate(a case report and literature review)

目的探讨前列腺导管腺癌的临床、病理特征及治疗方法。方法1例反复血精5个月,血尿4个月的患者直肠指诊示:前列腺右侧可及直径约1cm质软肿物。血清前列腺特异抗原(PSA)0.7ng/ml。前列腺穿刺活检提示前列腺腺癌。患者行根治性前列腺切除术。结果病理报告:前列腺右叶大导管腺癌,向外浸润右侧精囊,Gleason分级5/4(Sum=9),pT3b;免疫组化染色PSA(+),前列腺酸性磷酸酶(PAP)(++),雄激素受体(AR)(-)。患者术后恢复良好,血精、血尿消失,随访7年仍存活。结论前列腺导管腺癌是前列腺癌罕见的亚型,难于早期诊断,确诊主要依靠病理和免疫组化检查,治疗方法可采用根治性前列腺切除术。

Objective To evaluate the clinical and pathological characteristics and treatment of ductal adenocarcinoma of the prostate. Methods A case of ductal adenocarcinoma of the prostate gland was reported, and the relevant literature was reviewed to investigated the diagnosis and treatment of this disease. A 59-year-old male suffered from hemospermia and hematuria. A soft nodule in the right lobe of the prostate was found by digital rectal examination （DRE）. His serum prostatic specific antigen （PSA） level was 0.7ng/ml. The prostate biopsy result indicated prostate cancer and radical prostatectomy was performed on him. Results The postoperative pathology showed a primary ductal adenocarcinoma in the right lobe of prostate, which infiltrated the right vesicle. Gleason score was 5＋4 （Sum=9） and the pathologic stage was pT3b. With immunohistochemical staining, the tumor cells were positive for PSA and prostatic acid phosphatase, but negative for androgen receptor. Postoperatively, the patient recovered well with no hemospermia or hematuria. Du.ring a follow-up of 7 years, the patient was alive. Conclusion Ductal adenocarcinoma of the prostate is a clinically rare subtype of prostate cancer and difficult to be found in early stage. The diagnosis depends on histopathologic and immunohistochemical studies. Radical prostatectomy is recommended for this disease.