骨轉移攝護腺癌接受藥物去勢治療+ Abiraterone Acetate治療後

PSA值極低但繼發性肩膀轉移: 罕見病例報告

李亞哲¹、林威宇²

1.嘉義基督教醫院泌尿外科, 2.嘉義長庚醫院泌尿外科

Androgen Deprivation Therapy + Abiraterone Acetate in Metastatic Hormone-sensitive Prostate Cancer Displaying Metachronous Shoulder Metastasis Discordant with Undetectable PSA Level :A Case report

Ya-Che Lee¹, Wei-Yu Lin ²

1Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan

2 Division of Urology, Department of Surgery Chang Gung Memorial Hospital, Chia-Yi, Taiwan

Introduction:  

The presence of soft tissue metastases from a prostate adenocarcinoma is extremely rare. We report a case of metachronous shoulder metastasis from prostate adenocarcinoma even though PSA level is undetectable during the treatment with androgen deprivation therapy(ADT) plus abiraterone acetate (Abi).

Case report:  

A 78-year-old male presented with left shoulder pain, left arm limited ROM and a 12cm, firm mass in his left scapular. One year prior, he underwent transurethral resection of the prostate, which revealed Gleason 5+4 prostatic adenocarcinoma. Prostate specific antigen (PSA) was 1000 ng/mL on initial diagnosis. Bone scan revealed multiple lesions metasatsis. The patient began to receive treatment with ADT plus Abi. In a few months later , the PSA level declined rapidly to undetectable level (<0.025 ng/ml) and last to 15 th months, when sudden onset of a left scapular mass was noted. Computer tomography demonstrated a 12×5×4 cm mass arising from the left scapular compartment with near area bone destruction. Mass excision was done and pathology report revealed metastatic prostate cancer. Radiation therapy with 30 Gy/10fx followed for soft tissue metastasis. Although uncommon, while a new mass was noted in a patient with prostate cancer under treatment of ADT+Abi, it is important to suspect metachronous metastasis even with undetectable PSA level

Conclusions:

Although uncommon, while a new mass was noted in a patient with prostate cancer under treatment of ADT+Abi, it is important to suspect metachronous metastasis even with undetectable PSA level