骨転移を伴うアンドロゲン非依存性前立腺癌に対し, ゾレドロン酸,ジエチルスチルベストロール2リン酸(DES-DP)点滴静注療法が奏効した1例

Abstract

67歳男。頻尿で近医を受診し、PSA高値により経直腸前立腺生検を施行し中等度分化型腺癌Gleason score4+3と診断し、多発性骨転移を認めmaximum androgen blockage(MAB)療法を開始した。PSA値は低下したが2年6ヵ月後より徐々に上昇し、さらに約8ヵ月後より骨転移による腰痛が出現し放射線治療を行ったが、PSA値は上昇して疼痛は改善せずDES-DPによる三次内分泌療法目的で当科紹介となった。血清テストステロン値は去勢域で、シンチグラフィで多発性骨転移を認め、DES-DP点滴静注を開始して3週間後のゾレドロン酸点滴静注を行ったところ、速やかなPSA値の低下を認め測定感度以下まで低下した。ALPは一時的に上昇したが基準値範囲内に低下し、治療開始から7ヵ月後のシンチグラフィでは骨転移巣への集積低下を認め疼痛も完全に消失した。

A 67-year-old man was diagnosed as having prostate cancer with bone metastasis by his personal physician in 2002. He received androgen deprivation therapy, and then prostate specific antigen (PSA) declined to an undetectable level over the short term. In 2004, PSA gradually became elevated despite androgen deprivation therapy. Although secondary hormonal therapy was started, PSA continued to increase. With the complaint of back pain, he consulted our clinic. On initial examination at our clinic, PSA was 390.3 ng/ml and alkaline phosphatase (ALP) was 2, 338 IU/L. He was administered diethylstilbestrol diphosphate (DES-DP) and zoledronic acid intravenously and then PSA declined to an undetectable value again. In the course of the administration, liver enzymes were elevated and DES-DP administration was discontinued. However, with continued administration of zoledronic acid, PSA remained undetectable despite a 5-month interruption of DES-DP treatment. Thereafter, back pain completely disappeared.