攝護腺管狀腺癌 – 臺北榮總之臨床經驗報告
陳威任1, 黃奕燊1,2,3, 范玉華1,2,3, 黃逸修1,2,3, 鍾孝仁1,2,3, 郭俊逸1,2,3, 黃志賢1,2,3, 吳宏豪1,2,3, 張延驊1,2,3, 林登龍1,2,3, 陳光國1,2,3,
2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Prostate ductal adenocarcinoma – clinical experiences in taipei veterans general hospital
Wei-Jen Chen1, I-Shen Huang1,2,3, Yu-Hua Fan1,2,3, Eric I-Hsiu Huang1,2,3, Hsiao-Jen Chung1,2,3, Junne-Yih Kuo1,2,3, William J.S. Huang1,2,3, Howard H.H. Wu1,2,3, Yen-Hwa Chang1,2,3, Alex T.L. Lin1,2,3, Kuang-Kuo Chen1,2,3,
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University
Ductal adenocarcinoma of the prostate is a rare histological subtype of primary prostate cancer. Previous reports had showed that ductal adenocarcinoma of the prostate had a distinct behavior when compared to common acinar adenocarcinoma. About prostate acinar adenocarcinoma, previous studies had showed different incidence, risk, and prognostic condition, but due to the rarity of prostate ductal adenocarcinoma, the reports of prostate ductal adenocarcinoma in Asian population are still limited in small case series/reports. We intended to share our experiences and analyzed the treatment outcome.
Materials and Methods:
Patients with diagnosis of prostate ductal adenocarcinoma in our hospital during 2001~2014 were retrospectively reviewed. The initial symptoms, PSA level, treatment, and follow-up condition were retrieved for analysis.
18 patients had been diagnosed with prostate ductal adenocarcinoma during the period. The mean age of presentation was 75.5 years old (62-85). The most presenting symptoms is LUTS with elevated PSA. The median initial PSA level was 21.67ng/ml (2.47-629). The mean follow-up time was 29.1 months (2-126). 5 patients had radiographic distant metastasis or invasion to adjacent organ at initial staging. 12 patients were diagnosed by transrectal sonography-guided prostate biopsy; 2 patients were diagnosed by transurethral resection of prostate, 1 patient was diagnosed by transurethral resection of bladder tumor, and 3 patients received radical prostatectomy due to localized disease. Among these 3 patients, 2 patients were current disease-free with 14, 24 month follow-up. Another patient presented with bone metastasis 20 months after RRP and died of the disease 34 months after the operation despite hormone therapy. Totally only 5 patients had survived at least 3 years.
Ductal prostate adenocarcinoma tends to present with advanced clinical stage, relatively lower PSA levels then common prostate acinar carcinoma and the clinical behavior seems more aggressive. Clinically, we should regard these patients as a distinct group, which different from common prostate acinar adenocarcinoma patients.