前列腺小细胞癌(附一例报告并文献复习)

Small cell carcinoma of prostate:a case report and review of the literature

目的提高对前列腺小细胞癌的认识,探讨其诊治方法。方法分析2005年4月收治的1例前列腺小细胞癌患者的临床资料,并进行文献复习。患者65岁,因尿急1月,直肠指诊前列腺右叶突起明显,质地硬入院。血PSA1.92ng/ml。MRI:前列腺右侧肿块侵犯右侧膀胱精囊三角,并与直肠前壁相连。前列腺穿刺病理示:小细胞癌。行手术去势和前列腺与盆腔区域放疗。治疗失败后行EP方案化疗。结果内分泌治疗无效,2月后病情进展,广泛转移,患者骨痛,吞咽困难,血肿瘤标志物如NSE等升高。化疗有效,患者症状明显改善,血肿瘤标志物水平下降,可测量病灶稳定。化疗5疗程后病情进展,2006年3月18日死亡。结论前列腺小细胞癌预后差,内分泌治疗无效,化疗在治疗中占有重要地位。

Objective To study the diagnosis and treatment of small cell carcinoma of prostate. Methods A 65-year-old patient with pure small cell carcinoma of prostate was admitted because of complaints of urinary urgency for 1 month. DRE revealed enlarged prostates and hard consistency of the right lobe. Serum PSA level was 1.92ng/ml. MRI showed that the tumor in the right lobe of prostate involved the encroachment bladder, right seminal vesicle and rectum. Findings of hislological biopsy were consistent with a diagnosis of small cell carcinoma of prostate. The patient failed to respond to endocrine therapy and radiotherapy, so that combination chemotherapy with EP regimen was used. Results Two months after failing endocrine therapy, the disease progressed with multiple metastases. The patient felt ostealgia and dysphagia. Serum markers for neoplasia including NSE were elevated. Combination chemotherapy with EP regimen proved to be effective. Symptoms were relieved obviously, Serum markers for neoplasia declined, and measurable soft tissue foci became stable. Alter 5 courses of EP chemotherapy, the condition began to deteriorate and the patient died about one year after admission. Conclusions Small cell carcinoma of prostate has a very poor prognosis. Endocrine therapy is ineffective. Systemic chemotherapy is the most important treatment available.