若年性前立腺癌の2例

Abstract

症例1は45歳で, 排尿困難を主訴とした.前立腺特異抗原(PSA)が5000ng/ml以上と異常高値を示し, 経直腸前立腺針生検で中分化型腺癌(Gleason score 4+3)と診断, 全身精査により臨床病期T4N1M1b stage D2と判断した.DES-DP 500mg/day10日間点滴投与ののち両側精巣摘除術を施行し, PSAは10ng/ml前後で推移していたが, 1年半後310ng/mlに急上昇し, 右大腿骨頭部に転移を認めた.転移巣に対して放射線照射(total 15Gy)を施行し, その後エストラムチン投与などを行ったがPSA値は上昇し, 現在1039ng/mlで, 疼痛コントロール目的に入院中である.症例2は37歳で, 頻尿, 残尿感を主訴とした.PSAが24ng/mlと高値を示し, 経直腸前立腺針生検で低分化型腺癌(Gleason score 5+4)と診断, 臨床病期はT4N0M0 stage C2であった.TAB療法(LH-RH analog 3.75μg/ml+bicalutamide 80mg/day)および小骨盤領域への放射線照射(total 59.4Gy)を行い, 治療開始から1年5ヵ月の現在PSAは0.21ng/mlで再発は認めていない

Patients younger than 45 years with prostate cancer are rare. Between 1999 and 2002, we studied two cases of prostate cancer in men aged under 45 years. Case 1; a 45-year-old man admitted with the chief complaint of urination disorder. Serum level of prostate-specific antigen (PSA) was 5, 000 ng/ml or higher. Transrectal needle biopsy of the prostate revealed moderately differentiated adenocarcinoma. Computed tomography (CT) and bone scan showed para-aorta lymph node metastasis and bone metastasis. Hormone therapy was performed. Case 2; a 37-year-old man admitted with the chief complaint of pollakisuria and sense of residual urine. Serum level of prostate-specific antigen (PSA) was 24 ng/ml. Magnetic resonance imaging (MRI) showed that the prostate tumor invaded the bladder wall. Transrectal needle biopsy revealed poorly differentiated adenocarcinoma. Hormone therapy and radiation therapy were performed. Twenty-one cases reported in Japan in addition to the present cases are reviewed.