本文报道了 1例临床上罕见的前列腺癌肾脏转移病例.67岁男性患者,体检发现总前列腺特异性抗原(total prostate specific antigen,tPSA)升高,为 19.7 ng/mL,游离前列腺特异性抗原(free prostate specific an-tigen,fPSA)/tPSA 为0.06,外院前列腺穿刺活检确诊前列腺癌后于2023年7月至我院就诊,Gleason评分4+4=8分,前列腺MRI检查示周围带左后份DWI信号增高,邻近结构未见浸润,盆腔未见肿大淋巴结,全身骨显像检查未见明确肿瘤骨转移病灶,门诊诊断前列腺癌(T2cN0M0,高危),肾脏增强CT示右肾下份包膜下肾皮质区囊实性占位伴周围渗出,大小约6.3 cm×3.5 cm.多学科讨论后行超声引导下肾穿刺,病理结果显示符合前列腺癌转移,后予药物去势联合阿比特龙和泼尼松治疗.治疗1个月后复查PSA为7.2 ng/mL,睾酮为0.49 μg/L.患者确诊2个月后,因个人原因拒绝进一步治疗,绝食后死亡.
Renal metastasis from prostate cancer:a case report
A rare case of renal metastasis from prostate cancer was reported.A 67-year-old male patient was diagnosed with prostate cancer by prostate biopsy.His tPSA was 19.7 ng/mL(fPSA/tPSA 0.06),Gleason score was 4+4=8.and prostate MRI showed increased DWI signal in the peripheral zone without infiltration of adjacent structures or enlarged pelvic lymph nodes.Whole-body bone scan showed no clear bone metastases.Prostate canc-er was diagnosed in the outpatient department(T2cN0M0,high-risk).Contrast-enhanced CT showed a cystic sol-id space-occupying lesion with peripheral exudation in the subcapsular renal cortex of the lower right kidney,about 6.3 cm×3.5 cm in size.After multi-disciplinary treatment discussion,ultrasound-guided renal puncture was per-formed,and pathological report showed that prostate cancer had metastasized.Then drug castration combined with abiraterone and prednisone were treated.After 1 month of treatment,PSA and testosterone were 7.2 ng/mL and 0.49 μg/L.Two months after the diagnosis,the patient refused further treatment for personal reasons and died of hunger strike.
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