攝護腺黏液腺癌病例報告

黃昱凱¹, 黃逸修^1,2,3黃志賢^1,2,3

¹泌尿部 臺北榮民總醫院

²書田泌尿科學研究中心

 ³國立陽明交通大學醫學院泌尿學科

A Case Report of Mucinous Adenocarcinoma of the Prostate and Literature Review

Yu-Kai Huang¹, Eric Yi-Hsiu Huang^1,2,3, William JS Huang^1,2,3

¹Department of Urology, Taipei Veterans General Hospital

²Shu-Tien Urological Science Research Centerand Department of Urology,

³School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Prostate cancer predominantly manifests as acinar adenocarcinoma, with mucinous adenocarcinoma being an unusually rare variant subtype. Previous studies have indicated that this variant subtype exhibits aggressive behavior and a dismal prognosis. Our report aims to contribute to a rare case in our practice.

Case presentation:

An 89-year-old male with a history of hypertension and hypothyroidism had suffered from painless gross hematuria and increased urinary frequency persisting for one month. Digital rectal examination revealed an enlarged prostate with a smooth and elastic texture. The serum prostate-specific antigen (PSA) level was 2.67 ng/ml. Urine analysis indicated hematuria (RBC=50-99/HPF). Urine cytology showed negative for malignancy. Pelvic computed tomography (CT) identified a 2.8cm hypoenhanced lesion within the prostate. Thulium laser enucleation of the prostate (ThuLEP) was performed. A protruding papillary lesion with hemorrhage was discovered at the left prostate apex during the procedure. Pathological report confirmed mucinous adenocarcinoma, Gleason score 4+4=8, with grade group 4. Staging workup showed no evidence of distant metastasis. Considering his old age and performance status, the patient underwent androgen deprivation therapy (ADT) only. External beam radiation therapy (EBRT) was not recommended by the Radiation Oncologist due to the patient's advanced age and poor performance status. The patient has been well after a follow-up of 6 Months.

Discussion:

This case highlights the atypical clinical presentation of mucinous adenocarcinoma of the prostate, including a low serum PSA level and distinctive gross tumor appearance.

In previous studies, the prognosis of mucinous carcinoma of prostate remains controversial. The clinical progression of mucinous adenocarcinoma of the prostate is almost similar to acinar prostate adenocarcinoma, depending on the Gleason score and tumor involvement. Therefore, we realized the importance of accurate diagnosis and thorough evaluation to ensure appropriate treatment for the patient.