若年性前立腺癌の1例

Abstract

45歳男。患者はPSA高値を主訴とした。排尿障害等の自覚症状は認めなかったが, 直腸診では前立腺はクルミ大で, 圧痛はなく, 表面平滑で右葉に5mmほどの硬結が触知された。一方, 血液一般, 生化学検査では異常は認めず, PASは7.74ng/mlであったが, 画像所見では前立腺癌が疑われ, 経会陰的前立腺生検が施行された。前立腺両葉からGleason score 3+4, Who grade 2+IIIのadenocarcinomaが認められたが, 腹部ならびに骨シンチグラフィーでは明らかな転移は認めなかった。患者希望により他院で前立腺全摘除術行われた結果, 摘出標本の病理組織学的所見ではpT3a, N1と診断されたが, 追加治療を行わず, 目下は経過観察中である。

We report a case of prostate cancer in a 45-year-old. The patient was found to have an elevated prostate specific antigen (PSA) level at a general health check and was referred to our division. Serum level of PSA was 6.9 ng/ml. Digital rectal examination and magnetic resonance imaging revealed a small nodule on the right lobe. Transperineal needle biopsy of the prostate revealed adenocarcinoma at the bilateral lobe (Gleason score 3+4). Computed tomography and a bone scan showed no evidence of metastasis. The patient was diagnosed as cT2b, NO, MO, and underwent a radical prostatectomy. Patients younger than 45 with prostate cancer are rare, although the incidence of prostate cancer is increasing. Here, 25 cases previously reported in Japan in addition to the present case, are reviewed.