胸水貯留にて発見された前立腺癌の2例

Abstract

症例1(76歳)。頻尿, 腰痛を主訴とした。症例2(78歳)。C型肝炎の経過観察中であった。細胞診がそれぞれIIIbとVであったことから癌性胸水の診断はできていたが, 腫瘍マーカー検査でPSAの測定はなされておらず, 特に症例1では原発巣の同定に時間を要した。経直腸的前立腺生検を施行し, 前立腺癌の診断を得た上, MAB療法を開始したが効果が不十分で, EMPへ変更した。両症例ともいったんはPSAが低下を認めることもあったが, その後上昇し, 症例1は胸水増悪, 全身状態悪化により治療開始14ヵ月後に癌死した。一方, 症例2は副作用のため化学療法の継続を望まず, PSAが上昇するに従って胸水が徐々に増加し, 治療開始16ヵ月後に癌死した。

Prostate cancer is rarely detected from abnormal chest radiographs. We report two cases of prostate cancer detected from pleural effusion. Case 1 is a 76-year-old man who consulted the department of internal medicine of our hospital with dyspnea and abdominal fullness. Pleural effusion and multiple hepatic tumors of unknown origin were pointed out, but he refused any further investigation or treatment for them. Six months later, he consulted a family doctor with urinary frequency and lumbago. Increased serum prostate specific antigen (PSA) level to 864 ng/ml was recognized, then he was referred to our department. Under diagnosis of prostate cancer, T4NOM1c, maximal androgen blockade (MAB) was performed. Serum PSA level was decreased once to 8.1 ng/ml, but then rose gradually and he died 13 months after the beginning of the therapy. Case 2 was a 78-year-old man who was referred to our department to determine the origin of carcinomatous pleuritis detected in a routine general check up of hepatitis C. The serum PSA level was increased to 12, 900 ng/ml, and the diagnosis was prostate cancer, T3aNOM1c. Although MAB was performed, the serum PSA level did not decrease markedly. He died 16 month after the beginning of the therapy.