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目的:探讨前列腺小细胞癌的临床、病理特征及诊治方法。方法:分析1例前列腺小细胞癌患者的临床资料:患者男,54岁。因“尿频、尿急、排尿困难1个月”入院。直肠指诊前列腺Ⅲ°大,质硬,表面不光滑。血PSA为175.08 ng/ml。B超及MRI检查均提示前列腺癌,前列腺穿刺活检诊断为前列腺腺癌,行最大限度雄激素阻断治疗。9个月后症状加重,复查血PSA为7.41 ng/ml,MRI提示前列腺腺癌,行前列腺电切术,病理检查为前列腺小细胞癌。免疫组织化学示CD56(+),NSE(+),CgA(-),LCA(-)。遂以GP方案化疗:吉西他滨1800 mg,DDP150 mg,采用4周方案,一共行4个疗程。从第2个疗程开始同步局部放疗(3D-CRT,每次3 Gy,总量60 Gy)。结果:复查CT前列腺局部肿瘤消失,排尿通畅,但在随访的过程中,患者死于急性心肌梗死。结论:雄激素阻断治疗后,前列腺腺癌可能转化为小细胞癌,前列腺小细胞癌少见,恶性程度高,确诊需依靠临床及病理表现,强调早发现,早治疗。治疗以化疗为主,可辅以放疗,早期前列腺小细胞癌,也可行前列腺癌根治加化疗。
Objective: To investigate the clinical, pathological characteristics and diagnosis and treatment of prostatic small cell carcinoma. Methods: The clinical data of 1 patient with small cell carcinoma of the prostate were analyzed. The patient was male, 54 years old. Because of “urinary frequency, urgency, dysuria 1 month ” admission. Prostate digital rectal examination Ⅲ ° large, hard, the surface is not smooth. Blood PSA was 175.08 ng / ml. B ultrasound and MRI examination are prompted prostate cancer, prostate biopsy diagnosis of prostate adenocarcinoma, line maximal androgen blockade treatment. Nine months later, the symptoms were aggravated. The blood PSA was 7.41 ng / ml. Prostate adenocarcinoma was detected by MRI, and prostatectomy was performed by MRI. Prostatic small cell carcinoma was detected by pathology. Immunohistochemistry showed CD56 (+), NSE (+), CgA (-), LCA (-). Then the program of GP chemotherapy: gemcitabine 1800 mg, DDP150 mg, using a 4-week program, a total of 4 courses. Local radiotherapy (3D-CRT, 3 Gy per dose, total dose of 60 Gy) was started from the second course of treatment. Results: CT local tumor disappeared and urination was rechecked. However, during follow-up, the patient died of acute myocardial infarction. Conclusions: After androgen blockade therapy, prostate adenocarcinoma may be transformed into small cell carcinoma. Prostatic small cell carcinoma is rare and has a high degree of malignancy. The diagnosis depends on the clinical and pathological findings, and the early detection and early treatment are emphasized. Chemotherapy-based treatment can be supplemented by radiotherapy, early small cell carcinoma of the prostate, but also the radical prostatectomy plus chemotherapy.