摘要
目的探讨多学科诊疗模式(MDT)下前列腺黏液腺癌的临床表现、病理特征及全程化治疗策略。方法回顾性分析2020年9月—2023年4月空军军医大学西京医院收治的2例典型前列腺黏液腺癌患者的临床资料。结果病例1临床表现为肉眼血尿,初始前列腺特异性抗原(PSA)为1.2 ng/mL,行多参数磁共振(mpMRI)提示前列腺实性结节,临床分期T4N1Mx,68 Ga标记前列腺特异性膜抗原PET/CT(68 Ga-PSMA PET/CT):摄取值为4.2~5.3,穿刺活检为浸润性黏液腺癌,行前列腺及盆腔野外放疗+雄激素剥夺治疗(ADT)+抗雄治疗,复查影像学病灶明显缩小。病例2临床表现为排尿困难,初始PSA为91.78 ng/mL,mpMRI提示前列腺肿块侵犯膀胱,临床分期T4N1M1b,68 Ga-PSMA PET/CT:前列腺、盆腔淋巴结、多处骨病灶呈核素摄取增高,穿刺病理示前列腺腺癌伴有少许黏液腺癌成分,先行内分泌治疗,3个月后复查PSA降至0.083 ng/mL,影像学检查肿瘤明显缩小,行机器人辅助腹腔镜减瘤性前列腺切除术+扩大盆腔淋巴结清扫,术后继续行内分泌辅助治疗。结论前列腺黏液腺癌与传统腺泡腺癌具有不同的病理特征、临床表现及预后,MDT模式下的全程管理对这一特殊类型前列腺癌的诊断及治疗具有重要价值。
Objective To explore the clinicopathological characteristics and comprehensive treatment strategies of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment(MDT)mode.Methods Data of two patients with typical prostate mucosa adenocarcinoma treated in our hospital during Sep.2020 and Apr.2023 were retrospectively analyzed.Results In case 1,the clinical manifestation was macroscopic hematuria;multiparametric magnetic resonance imaging(mpMRI)indicated solid prostatic nodules,clinical stage T4N1Mx;initial prostate specific antigen(PSA)was 1.2 ng/mL;6868Ga-prostate specific membrane antigen PET/CT(68 Ga-PSMA PET/CT)suggested abnormal uptake of nuclear lesions in the prostate(SUV4.2-5.3);biopsy results indicated invasive mucinous adenocarcinoma.After prostate and pelvic field radiotherapy+androgen deprivation therapy(ADT)+antihypertensive treatment,lesions were significantly reduced,and hematuria symptoms were relieved.In case 2,the clinical manifestation was dysuria;initial PSA was 91.78 ng/mL;mpMRI suggested invasion of prostate mass into the bladder and clinical stage of T4N1M1b;68 Ga-PSMA PET/CT indicated prostate and pelvic lymph nodes,and multiple bone lesions showed increased nuclide uptake;biopsy results indicated prostate adenocarcinoma with mucinous adenocarcinoma.Initial endocrine treatment was performed.After 3 months,PSA was reduced to 0.083 ng/mL,and imaging showed the tumor was significantly reduced.Robotic-assisted laparoscopic tumor prostatectomy with extended pelvic lymph node dissection was performed,and endocrine adjuvant therapy was continued after surgery.Conclusion Prostate mucosa adenocarcinoma has different clinicopathological characteristics and prognosis from conventional acinar adenocarcinoma,and the whole-process management under MDT mode is of great value in the diagnosis and treatment of this disease.
作者
武鹏
王福利
张静
任静
全志永
徐婉妮
魏丽春
秦卫军
WU Peng;WANG Fuli;ZHANG Jing;REN Jing;QUAN Zhiyong;XU Wanni;WEI Lichun;QIN Weijun(Department of Urology,,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Pathology,,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Radiology,,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Nuclear Medicine,,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Radiotherapy,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)
出处
《现代泌尿外科杂志》
CAS
2024年第2期154-157,共4页
Journal of Modern Urology
关键词
前列腺癌
黏液腺癌
全程管理
多学科诊疗模式
内分泌治疗
机器人辅助腹腔镜手术
减瘤性前列腺切除术
prostate cancer
mucosa adenocarcinoma
full-process management
multidisciplinary diagnosis and treatment mode
endocrine treatment
robotic-assisted laparoscopic surgery
cytoreductive prostatectomy
作者简介
通信作者:秦卫军,主任医师。E-mail:qinwj@fmmu.edu.cn;武鹏,医学博士,副主任医师。研究方向:泌尿系肿瘤的微创手术、前列腺癌的精准诊断治疗及全程管理。E-mail:fmmuwupeng@163.com。
