背景:治疗诱导的神经内分泌前列腺癌(t-NEPC)代表了一种高度侵袭性的去势抵抗性前列腺癌亚型,通常由持续雄激素剥夺治疗(ADT)后的前列腺腺癌(AdPC)引起。然而,目前t-NEPC的治疗方法有限,远不能令人满意。根据我们有限的知识,关于t-NEPC相关出血处理的报告很少见.这里,我们报告了1例慢性激素治疗并伴有原发肿瘤严重出血后形成t-NEPC的病例,并分享了我们处理t-NEPC肿瘤进展导致的严重血尿的经验.
方法:一名80岁的男性患者,由于多发性骨转移,通过病理学诊断为晚期AdPC。然后,他接受了包括比卡鲁胺和戈舍瑞林在内的ADT。疾病稳定20个月后,癌症进展迅速,并出现由原发肿瘤出血引起的严重肉眼血尿。原发性肿瘤的二次活检的组织病理学分析证实了神经内分泌前列腺癌,随后的基因检测揭示了RB1和FOXA1的种系突变。控制出血和缓解症状,患者接受超选择性前列腺动脉栓塞术(PAE)治疗.左阴部内动脉和右前列腺动脉栓塞后,血尿迅速缓解并消失。然而,由于体质虚弱,该患者不适合接受铂类化疗.连续应用戈舍瑞林维持血清睾酮的去势水平。同时,前列腺肿瘤的姑息性放射治疗,高危淋巴结引流区(包括髂和主动脉旁淋巴结,髂内淋巴结,行骶前淋巴结和闭孔神经淋巴结)和骨转移(右骶髂关节和胸椎),减轻疼痛。不幸的是,该患者在初次诊断后近27个月最终死于恶病质和多器官功能衰竭。
结论:治疗由t-NEPC进展引起的严重血尿,超选择性PAE可能是一种快速有效的止血方法。
BACKGROUND: Treatment-induced neuroendocrine prostate cancer (t-NEPC) represents a highly aggressive subtype of castration-resistant prostate cancer that commonly arises from prostate adenocarcinoma (AdPC) after continuous androgen deprivation therapy (ADT). However, current treatments for t-NEPC are limited and far from satisfactory. According to our limited knowledge, report regarding the management of t-NEPC related hemorrhage is rare. Here, we report a
case of t-NEPC formation after chronic hormonal therapy accompanying with severe bleeding in primary tumor and share our experiences to deal with the severe hematuria resulting from the progression of t-NEPC tumor.
METHODS: An 80-year-old man with a significantly high prostate-specific antigen was diagnosed via pathology as advanced AdPC due to multiple bone metastases. He then received ADT including bicalutamide and goserelin. After 20 months of stable disease, the cancer rapidly progressed and presented with severe gross hematuria caused by bleeding of the primary tumor. The histopathologic analysis of a secondary biopsy of the primary tumor confirmed neuroendocrine prostate cancer, and subsequent genetic testing revealed germ-line mutations in the RB1 and FOXA1. To control the bleeding and relieve symptoms, the patient was treated with superselective prostate artery embolization (PAE). After the left internal pudendal artery and the right prostatic artery were embolized, hematuria was quickly alleviated and disappeared. However, the patient was not a suitable candidate to platinum-based chemotherapy due to weak constitution. Goserelin was continuously applied to maintain castration level of serum testosterone. Meanwhile, palliative radiotherapy to the prostate tumor, high-risk lymph node drainage areas (including iliac and para-aortic lymph nodes, internal iliac lymph nodes, presacral lymph nodes and obturator nerve lymph nodes) and bone metastases (right sacroiliac joint and thoracic vertebra) was performed and relieved the pain. Unfortunately, this patient eventually died of cachexia and multiple organ failure nearly 27 months after initial diagnosis.
CONCLUSIONS: To treat severe hematuria caused by progression of t-NEPC, superselective PAE may be a rapid and efficient way to stop bleeding.