摘要/Abstract
摘要： 患者，男性，67岁。2018年8月因“进行性排尿困难伴排便困难7月余”就诊，查tPSA 24.50 ng/mL，MRI提示前列腺癌，穿刺提示前列腺癌Gleason评分9分（5+4），入院后TNM分期：cT4N0M0。予内分泌治疗联合多西他赛化疗后行前列腺癌根治术，结合术后病理诊断为高危局限性前列腺癌，pT4N0M0，Gleason评分9分。予以局部放射治疗+内分泌治疗。2019年6月胸部CT以及PET-CT提示全身多发淋巴结转移、骨转移可能。2019年6月10日行颈淋巴结穿刺活检，CgA（散在+），Syn（+），PSMA（+），PSA（散在+），可符合前列腺癌转移，诊断为前列腺大细胞神经内分泌癌。2019年6月起给予阿比特龙治疗，治疗2周后有所好转，治疗6周后复查PSA再次上升至26.20 ng/mL,结合基因检测结果提示AR扩增，遂给予更换成多西他赛联合顺铂化疗。2019年11月5日复查胸部CT显示纵隔、肺门淋巴结明显缩小，心包积液、胸腔积液较前有明显吸收。该例患者随访至2020年5月，仍然存活，ECOG评分为0分。
关键词: 前列腺, 大细胞, 神经内分泌癌
Abstract:
In August, 2018, a 67-year-old man presenting progressive dysuria and defecation difficulty for 7 months went to our hospital. tPSA was 24.50 ng/mL. MRI examination suggested prostate cancer, and the prostate biopsy confirmed it. Gleason score was 9 (5+4), and TNM stage after admission was cT4N0M0. Radical prostatectomy was performed after castration, combined with docetaxel chemotherapy. After operation, the patient was diagnosed as high-risk localized prostate cancer with pT4N0M0 and Gleason score 9. Local radiotherapy and castration were then given to the patient. Chest CT and PET-CT in June 2019 suggested multiple lymph node metastasis and bone metastasis. A cervical lymph node biopsy was then performed on June 10th, 2019, with CgA (+), Syn (+), PSMA (+), and PSA (+), which was consistent with prostate cancer metastasis. So the patient was diagnosed as large cell neuroendocrine carcinoma of the prostate. The patient has been treated with Abiraterone since June, 2019, which was effective in the first 2 weeks, but after 6 weeks of treatment, PSA rose again to 26.20 ng/mL. Gene detection results suggested AR amplification, so we replaced Abiraterone with docetaxel combined with cisplatin. Chest CT on November 5th, 2019 showed that the size of mediastinal and hilar lymph nodes were significantly reduced, and the pericardial effusion and pleural effusion were obviously absorbed. The patient was still alive at the end of the follow up. ECOG score was 0.
Key words: prostate, large cell, neuroendocrine carcinoma
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