根治的前立腺全摘除術後, 膀胱転移をきたした前立腺癌の1例

Abstract

67歳男.63歳時に中分化型腺癌に対し根治的前立腺全摘除術, 両側精巣摘除術を受けた.その後, 経過観察となっていたが, 肉眼的血尿を自覚し, 更に腹部骨盤CT, 膀胱鏡で膀胱右側壁に隆起性病変を認め, 精査加療目的で入院となった.遠隔転移を伴う浸潤性膀胱腫瘍と診断し, 経尿道的膀胱腫瘍切除術を施行した.術後も血尿が持続し, 血尿のコントロール目的に単純膀胱摘除術, 両側尿管皮膚瘻造設術を施行した.前立腺癌及び膀胱転移巣は共に血管侵襲, リンパ管侵襲が著明で, PSA染色が一部で陽性であることから前立腺癌の膀胱転移と診断した.内服治療で経過観察していたが, 膀胱摘除術後5ヵ月目に癌死した

We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.