臺灣嚴重特殊傳染性肺炎(COVID-19)之衝擊:攝護腺淋巴癌
唐慈翊1,2、詹鎮豪1、李永進1、王巽玄1、耿俊閎1、曹曜軒1、吳怡萱1、沈榮宗1
高雄市立小港醫院1泌尿科
高雄醫學大學附設醫院2泌尿科
Impact of COVID-19 on Prostate cancer diagnosis and treatment: Prostate lymphoma
Tsz-Yi Tang1, Jhen-Hao Jhan1, Yung-Chin Lee1, Hsun-Shuan Wang, Jiun-Hung Geng, Yao-Hsuan Tsao, Yi-Hsuan Wu, Jung-Tsung Shen
1Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Purpose:
Interruptions in care and services due to the COVID-19 epidemic are causing significant worry, but the gaps in screening and treatment for prostate lymphoma are not well recorded. We report a delayed diagnosis of prostate lymphoma.
Case report
A 74-year-old man presented to the urological clinic with gradually progressing symptoms of low urinary tract obstruction and constipation. Four months previously, prostatic echography showed a hypoechoic lesion in the left peripheral zone. Digital rectal examination showed elastic without any hard nodule. Except for mildly elevated CEA, other tumor markers, including alpha-fetoprotein, CA-125, and CA-199, were normal. Prostate-Specific Antigen (PSA) level was below 0.5 ng/ml, which was within the normal range. Multiparametric-magnetic resonance imaging (mp-MRI) showed prostate cancer over the left peripheral zone with seminal vesicle and rectum involvement, cT4 (Figure 1). Transrectal ultrasound prostate biopsy showed benign prostate tissue with similar morphology to psudoangiomatous stromal hyperplasia (PASH). The result of pathology was incompatible with that of clinical imaging. However, the repeat biopsy was delayed for four months due to the COVID-19 pandemic. Notably, the tumor rapidly grew from 3 cm to 10.2 cm on the sequential MRI image (Figure 2) during this period. Repeat biopsy and transurethral resection of the prostate were done. Pathology showed diffuse large B cell lymphoma. The patient received eight cycles of chemotherapy with an R-CHOP regimen, including rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone, and radiotherapy. He had complete remission for one year after treatment.
Conclusion:
We report a case of prostate DLBCL that grew rapidly, which was initially misdiagnosed and delayed to treat due to global COVID-19 epidemic. During COVID-19 pandemic, repeated biopsies are delayed, hence postponing treatment for this rapidly progressing cancer.