Long-Term Remission of Metastatic Small Cell Carcinoma of the Prostate

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作者：Aleks ; ra Ciszewski ; Dustin Shackleton ; Tomasz M. Beer
关键词：Housing ; Capital gains ; Taxation ; Mobility
刊名：Urology
出版年：2008
期刊代码：267_00904295
类别：med
出版时间：March 2008
卷：71
期：3
页码：546.e3-546.e4
文件大小：714 K

摘要

A total of 14 men with an average age of 72 years (range 62 to 81) were enrolled in the study. All had biopsy proven prostate cancer with increasing prostate specific antigen (PSA) (1.0 to 10.3 ng/ml). The seminal vesicles were not routinely biopsied. Metastatic disease was assayed in all men with bone scan and in later patients with abdominopelvic computerized tomography. Patients had ThermoRods placed under transrectal ultrasound guidance, similar to brachytherapy. The pre-plan was rigorously followed to produce a 3-dimensional array with rods separated by 1 cm across the short axis. Patients were treated in a magnetic field for 1 hour. Urethral and rectal temperatures were also monitored and cooled appropriately. Serial PSA measurements and 6 month posttreatment biopsies were obtained after the procedure.

Results

Average time since radiation was 4.5 years. PSA nadir values after radiation were between 0.3 and 2.2 ng/ml. Prostatic temperatures were homogeneously increased greater than 50C, while rectal and urethral temperatures did not exceed 44C at any point. The urethral catheter was removed 2 weeks postoperatively in all cases. Six months after the procedure 8 of the 14 men (57%) had a PSA decrease to less than 0.1 ng/ml. Complications included urinary retention as well as incontinence. Incontinence was generally temporary and only 1 patient (7%) had long-term incontinence. Most patients were impotent after treatment. Of the patients 21%experienced urinary retention. Five patients (36%) needed to undergo secondary procedures after therapy, including transurethral prostate resection in 2, balloon dilation in 1, cystoscopic removal of necrotic tissue in 1 and bladder irrigation in 1.

Conclusions

This novel means of thermal ablation produces significant PSA decreases in patients. Morbidity is predominantly in the form of incontinence and impotence. Incontinence is generally temporary. The use of ferromagnetic rods enables the precise control of tissue destruction with the sparing of immediately adjacent structures. The technology uses skills familiar to the urologist and avoids radiation. The durability of the PSA response and incidence of late morbidity remain to be defined.

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Prostate cancer has become the most commonly diagnosed cancer in American men. It is second only to lung cancer in causing cancer deaths⁹ in this group and is responsible for nearly 3%of all deaths in American men over the age of 55.⁸² The common acinar prostatic adenocarcinoma constitutes 95%of all malignant prostatic neoplasms. Numerous rare morphologic variants of prostatic carcinoma have been identified in the last two decades. These atypical prostate cancers account for less than 5%of all prostatic malignancies. They may arise from the prostatic epithelium or stroma, or from ectopically located cells within the prostate. These tumors often present with similar signs and symptoms as typical prostatic adenocarcinoma. The natural history and response to therapy, however, may differ markedly.

It is important to recognize and diagnose special variants accurately, and understand the criteria that distinguish these from benign mimics. Accurate diagnosis of these rare prostatic malignancies may have important implications with respect to both treatment and prognosis. Although imaging may potentially have a role in differentiation of rare prostatic malignancies from typical adenocarcinoma, no modality has proved specific enough in this regard and therefore tissue diagnosis (biopsy) is required in all cases. Unusual tumors arising in the prostate raise questions of tumor origin, particularly whether the tumor represents metastasis from another site. This article reviews the important features of the atypical prostatic malignancies, listed as follows:

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Results

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Case Report