内分泌療法が著効を示した粟粒性肺転移を伴う前立腺癌の1例

Abstract

66歳男.胸部異常陰影を指摘され, 原因巣検索中に排尿困難が出現した.末梢白血球が8900/μl, 前立腺特異抗原(PSA)が134.9ng/mlと上昇していた.骨盤MRIでは前立腺中央から左葉にかけてT1強調像で等信号, T2強調像で低信号の腫瘤を認め, 膀胱頸部及び左精嚢への浸潤も疑われた.経直腸的前立腺生検では高分化癌であった.肺転移を伴う前立腺癌stage D2と診断し, リン酸ジエチルスチルベストロール(DES)を250mg/日点滴静注14日間投与し, その後酢酸ゴセレリン及びフルタミドによるtotal androgen blckade療法を開始した.DES終了時のPSAは8.4ng/mlと著明に低下し, 胸部X線でも肺転移巣の著明改善を認めた.診断から3年6ヵ月経過し, 再燃や転移はない

A 66-year-old, man was referred to our hospital for further examination of multiple pulmonary nodules on chest X-ray performed on medical examination. He was referred to our clinic because his chief complaint was poor urinary stream. Prostatic cancer was suspected on digital rectal examination and magnetic resonance imaging. Serum prostatic specific antigen (PSA) level was 134.9 ng/ml. Histological examination of transrectal prostatic sextant biopsy revealed well differentiated adenocarcinoma of prostate. Abdominal computed tomography-scan, gastro-intestinal tract examination and bone scintigraphy demonstrated no other primary lesions or distant metastases. Under the diagnosis of prostatic cancer with multiple pulmonary metastasis, we performed total androgen blockade (TAB) consisting of luteinizing hormone releasing hormone agonist and flutamide following dietylstilbestrol (DES) intravenous injection therapy. After three months, pulmonary nodules disappeared on chest X-ray and PSA level decreased to below 0.1 ng/ml. Pulmonary nodules also disappeared on CT-scan after six months after TAB. He is alive and free from the recurrence for 42 months.