内容紹介
Summary
Although postoperative recurrence or prostate cancer metastasis is usually accompanied by high prostate-specific antigen(PSA)levels, it may occur even if PSA level is within the normal range. Neuroendocrine differentiation(NED), which is one of such cases, causes rapid disease progression. A man in his 70s underwent total prostatectomy for prostate cancer with high PSA levels. Twenty-two months later, liver, lung, and bone metastases appeared even though the PSA levels were normal. The levels of both neuron-specific enolase and pro-gastrin-releasing peptide were elevated and the patient was clinically diagnosed with NED. Although systemic chemotherapy was administered, the outcome was progressive disease. Transcatheter arterial chemoembolization(TACE)was opted because liver metastases were one of the prognostic factors. Four types of chemotherapy drugs(cisplatin 20 mg, docetaxel 20 mg, 5-FU 250 mg, and bevacizumab 100 mg)were infused through the right and left hepatic arteries, followed by embolization with HepaSphereTM. The liver tumors were remarkably reduced in size and the levels of tumor markers were reduced in 5 sessions. This treatment would avoid the lethal liver trouble; however, the patient died 7 months after the first session of TACE.
要旨
前立腺癌術後再発ではPSA高値となることが一般的であるが,PSA値正常であっても神経内分泌分化(neuroendocrine differentiation: NED)を伴い,急速な病状の進行を来すことが知られている。治療法は確立しておらず,予後は極めて不良である。症例は70歳台,男性。前立腺癌に対して全摘術が施行された。術前PSA値は11.606 ng/mLで,低分化型腺癌と診断された。術後22か月間ホルモン療法が施行された後,PSA値は正常範囲内で肝,肺,骨に転移が出現した。NSE,ProGRPは上昇し,NEDが疑われた。PE療法が施行されたがPDとなり,肝動注塞栓術(TACE)が選択された。動注は左右肝動脈から4:6の割合で行われ,直後にヘパスフィア™による塞栓術が行われた。5回の治療により肝不全は免れ,7か月の生存を得た。
目次
Although postoperative recurrence or prostate cancer metastasis is usually accompanied by high prostate-specific antigen(PSA)levels, it may occur even if PSA level is within the normal range. Neuroendocrine differentiation(NED), which is one of such cases, causes rapid disease progression. A man in his 70s underwent total prostatectomy for prostate cancer with high PSA levels. Twenty-two months later, liver, lung, and bone metastases appeared even though the PSA levels were normal. The levels of both neuron-specific enolase and pro-gastrin-releasing peptide were elevated and the patient was clinically diagnosed with NED. Although systemic chemotherapy was administered, the outcome was progressive disease. Transcatheter arterial chemoembolization(TACE)was opted because liver metastases were one of the prognostic factors. Four types of chemotherapy drugs(cisplatin 20 mg, docetaxel 20 mg, 5-FU 250 mg, and bevacizumab 100 mg)were infused through the right and left hepatic arteries, followed by embolization with HepaSphereTM. The liver tumors were remarkably reduced in size and the levels of tumor markers were reduced in 5 sessions. This treatment would avoid the lethal liver trouble; however, the patient died 7 months after the first session of TACE.
要旨
前立腺癌術後再発ではPSA高値となることが一般的であるが,PSA値正常であっても神経内分泌分化(neuroendocrine differentiation: NED)を伴い,急速な病状の進行を来すことが知られている。治療法は確立しておらず,予後は極めて不良である。症例は70歳台,男性。前立腺癌に対して全摘術が施行された。術前PSA値は11.606 ng/mLで,低分化型腺癌と診断された。術後22か月間ホルモン療法が施行された後,PSA値は正常範囲内で肝,肺,骨に転移が出現した。NSE,ProGRPは上昇し,NEDが疑われた。PE療法が施行されたがPDとなり,肝動注塞栓術(TACE)が選択された。動注は左右肝動脈から4:6の割合で行われ,直後にヘパスフィア™による塞栓術が行われた。5回の治療により肝不全は免れ,7か月の生存を得た。