背景:2022年,世界卫生组织修订的前列腺癌分类中增加了一种新的前列腺癌亚型,称为治疗相关神经内分泌前列腺癌(t-NEPC)。t-NEPC案件正在增加,也没有既定的标准治疗。
方法:一名49岁男性患者因排尿困难被转诊至我们科室。直肠检查和前列腺活检显示石质硬度和前列腺腺癌,分别。影像学检查证实存在多个骨和淋巴结转移。患者开始接受雄激素剥夺疗法和雄激素受体信号抑制剂的前期治疗,这导致前列腺特异性抗原(PSA)水平显着降低(>90%)。患者在6个月后出现肾功能衰竭,可归因于局部疾病进展。同时,神经元特异性烯醇化酶(NSE)水平升高,盆腔淋巴结转移增大,没有PSA进展。
结果:用于癌症基因组分析的活检标本显示BRCA2和PTEN缺失,AR扩增,和TMPRSS2-ERG融合基因的存在。基于NSE和BRCA2突变的增加,最终诊断为有BRCA2突变的t-NEPC.患者接受多西他赛化疗和盆腔放疗。随后,他接受了奥拉帕利治疗。他的NSE水平下降了,他获得了完整的响应(CR)。然而,奥拉帕利管理后18个月,尽管没有盆腔肿瘤复发,但仍出现脑转移,患者的PSA水平仍然很低。因此,患者接受了伽玛刀和全脑放疗切除脑转移瘤,但约3个月后死亡.
■基于铂的化疗通常用于治疗t-NEPC,但很少有关于奥拉帕尼在BRCA2突变患者中的有效性的报道。在文献综述中,该病例显示,奥拉帕利单药无铂类化疗的疗效持续时间最长.此外,相对罕见的发生,长期CR后前列腺癌的致命性脑转移表明需要定期进行脑影像学检查.
BACKGROUND: A new subtype of prostate cancer called treatment-related neuroendocrine prostate carcinoma (t-NEPC) was added to the revised World Health Organization classification of prostate cancer in 2022. t-NEPC cases are increasing, and there is no established standard treatment.
METHODS: A 49-year-old male patient was referred to our department for dysuria. A rectal examination and a prostate biopsy revealed stony hardness and prostate adenocarcinoma, respectively. Imaging studies confirmed the presence of multiple bone and lymph node metastases. The patient was started on upfront treatment with androgen deprivation therapy and an androgen receptor signaling inhibitor, which resulted in a significant (>90%) decrease in prostate-specific antigen (PSA) levels. The patient experienced postrenal failure 6 months later, attributable to local disease progression. Concurrently, there was an elevation in neuron-specific enolase (NSE) levels and an enlargement of pelvic lymph node metastases, without PSA progression.
RESULTS: Biopsy specimen for cancer genome profiling revealed deletion of BRCA 2 and PTEN, AR amplification, and the presence of the TMPRSS2-ERG fusion gene. Based on increased NSE and BRCA2 mutations, a diagnosis of t-NEPC with BRCA2 mutation was eventually made. The patient received docetaxel chemotherapy and pelvic radiotherapy. Subsequently, he was treated with olaparib. His NSE levels decreased, and he achieved a complete response (CR). However, 18 months following the olaparib administration, brain metastases appeared despite the absence of pelvic tumor relapse, and the patient\'s PSA levels remained low. Consequently, the patient underwent resection of the brain metastases using gamma knife and whole-brain radiotherapy but died approximately 3 months later.
UNASSIGNED: Platinum-based chemotherapy is often administered for the treatment of t-NEPC, but there are few
reports on the effectiveness of olaparib in patients with BRCA2 mutations. In a literature review, this
case demonstrated the longest duration of effectiveness with olaparib alone without platinum-based chemotherapy. Additionally, the occurrence of relatively rare, fatal brain metastases in prostate cancer after a long period of CR suggests the necessity of regular brain imaging examinations.