高危局限晚期前列腺癌内分泌治疗后病理上皮内瘤变转化:1例报道并前列腺癌新辅助治疗意义再探  

Effect of hormone therapy on reversing high-risk localized advanced prostate cancer to prostatic intraepithelial neoplasia:a case report and further research of neoadjuvant therapy

作　　者：杨俊[1] 胡嘏[1] 管维[1] 张宗彪[1] 卢宇超[1] 陈忠[1] 胡志全[1] 王少刚[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《现代泌尿生殖肿瘤杂志》2017年第3期167-169,174,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的报道1例高危局限晚期前列腺癌经新辅助内分泌治疗后的组织病理改变特点,探讨新辅助治疗对此类患者的临床意义。方法 1例高危局限晚期前列腺癌患者(T4N0M0),MRI检查提示前列腺占位,大小约65mm×85mm×68 mm,伴盆腔周围器官侵犯;前列腺靶向穿刺结果提示前列腺腺癌(Gleason 5+4);行新辅助内分泌治疗(最大限度雄激素阻断)6个月后接受机器人前列腺癌根治术并盆腔淋巴清扫。术后随访16个月。结果患者经最大限度雄激素阻断内分泌治疗6个月后,前列腺MRI平扫+PWI+DWI提示肿块未见;术后病理提示:全组织制片,镜下见前列腺组织增生伴局灶性高级别上皮内瘤变,所有切片未见癌组织,各切缘及淋巴结均阴性。术后6周患者复查总PSA<0.008ng/ml。术后接受雄激素剥夺治疗16个月,总PSA均低于0.02ng/ml。结论高危局限晚期前列腺癌经内分泌治疗后其病理可能出现上皮内瘤变样的逆转,新辅助治疗后可改善此类高危患者前列腺癌根治手术效果。Objective To report the pathological change of the patient with high-risk localized advanced prostate cancer after hormone therapy,and to discuss the value of the neoadjuvant therapy. Methods A patient with high-risk localized advanced prostate cancer（T4N0M0）underwent robotic assisted radical prostatectomy and pelvic lymph node dissection after 6-month hormone therapy（maximum androgen blockage,MAB）.We analysed the changes of the imaging and pathology.The patient was followed up for 16 months,and the value of the neoadjuvant therapy for this patient was discussed. Results The tumor couldn＇t be detected from MRI after 6-month hormone therapy.The postoperative pathological results showed that no cancer was found from the prostate gland and the lymph node and all the margins were negative.Six weeks postoperatively,the total PSA level of the patient was below 0.008ng/ml.After the follow-up 16 months,the total PSA level was below 0.02ng/ml. Conclusions Hormone therapy could reverse high-risk localized advanced prostate cancer to prostatic intraepithelial neoplasia,so this might benefit the surgery results for this kind of patients.

关 键 词：前列腺癌 上皮内瘤变 新辅助治疗 最大限度雄激素阻断 

分 类 号：R737.25[医药卫生—肿瘤]