现代泌尿外科杂志2024,Vol.29Issue(2) :154-157.DOI:10.3969/j.issn.1009-8291.2024.02.012

前列腺黏液腺癌多学科诊疗模式诊治2例报告及文献复习

Diagnosis and treatment of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment mode:2 cases report and literature review

武鹏 王福利 张静 任静 全志永 徐婉妮 魏丽春 秦卫军
现代泌尿外科杂志2024,Vol.29Issue(2) :154-157.DOI:10.3969/j.issn.1009-8291.2024.02.012

前列腺黏液腺癌多学科诊疗模式诊治2例报告及文献复习

Diagnosis and treatment of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment mode:2 cases report and literature review

武鹏 1王福利 1张静 2任静 3全志永 4徐婉妮 2魏丽春 5秦卫军1
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作者信息

  • 1. 空军军医大学西京医院 泌尿外科 陕西西安 710032
  • 2. 空军军医大学西京医院 病理科 陕西西安 710032
  • 3. 空军军医大学西京医院 放射科 陕西西安 710032
  • 4. 空军军医大学西京医院 核医学科 陕西西安 710032
  • 5. 空军军医大学西京医院 放疗科,陕西西安 710032
  • 折叠

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,68Ga标记前列腺特异性膜抗原PET/CT(68Ga-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,68Ga-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.

Abstract

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(68Ga-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;68Ga-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.

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

Key words

prostate cancer/mucosa adenocarcinoma/full-process management/multidisciplinary diagnosis and treatment mode/endocrine treatment/robotic-assisted laparoscopic surgery/cytoreductive prostatectomy

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出版年

2024
现代泌尿外科杂志
西安交通大学

现代泌尿外科杂志

CSTPCD
影响因子:1.106
ISSN:1009-8291
参考文献量16
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