Neuroendocrine Prostate Cancer After Hormonal Therapy: Knowing Is Half the Battle
Neuroendocrine Prostate Cancer After Hormonal Therapy: Knowing Is Half the Battle
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DOI：
10.1200/jco.2014.57.5100
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发表时间：
2014-10-20
影响因子：
45.3
通讯作者：
Tagawa, Scott T.
中科院分区：
文献类型：
--
作者：
Tagawa, Scott T.
一名55岁接受前列腺癌筛查的健康男性发现前列腺特异性抗原（PSA）为19 ng/mL，随后的活检显示Gleason 3+4前列腺腺癌。他接受调强放疗加1年的leuprolide治疗。大约2年后生化复发后，他接受间歇性激素治疗，直到6年后出现明显的转移性疾病。他的肿瘤对添加比卡鲁胺或使用一种新型药物的治疗方案无反应，他迅速发展为有症状的进展性疾病。随后，他接受了多西他赛、阿比特龙和强的松治疗，作为临床试验的一部分，获得了症状、生化和放射学反应（临床过程总结于表1）。在10个周期的多西紫杉醇治疗后，他继续使用阿比特龙和强的松大约1年，直到生化进展，再用6个月，直到注意到放射学改变。当他被注意到转移性淋巴结的大小轻微增加，不符合RECIST的进展标准时，他接受了与去势抵抗性前列腺腺癌一致的活检（图1A）。三个月后，他出现症状和影像学进展，包括肝转移的发展。肝转移活检显示神经内分泌前列腺癌（NEPC；图1B）。
A healthy man undergoing screening for prostate cancer at age 55 years was found to have a prostate-specific antigen (PSA) of 19 ng/mL, and a subsequent biopsy disclosed Gleason 3+4 prostatic adenocarcinoma. He received intensity-modulated radiation therapy plus 1 year of leuprolide. Following biochemical recurrence approximately 2 years later, he then received intermittent hormonal therapy until the development of overt metastatic disease 6 years later. His tumor did not respond to the addition of bicalutamide or protocol-based treatment involving a novel agent, and he developed rapidly progressive, symptomatic disease. He subsequently received docetaxel, abiraterone, and prednisone as part of a clinical trial that achieved symptomatic, biochemical, and radiographic response (clinical course summarized in Table 1). Following 10 cycles of docetaxel, he stayed on abiraterone and prednisone for approximately 1 year until biochemical progression and another 6 months until radiologic change was noted. When he was noted to have a mild increase in the size of metastatic disease to lymph nodes not meeting RECIST criteria for progression, he underwent a biopsy consistent with castration-resistant prostatic adenocarcinoma (Fig 1A). Three months later, he developed both symptomatic and radiographic progression, including the development of liver metastases. Biopsy of a liver metastasis revealed neuroendocrine prostate cancer (NEPC; Fig 1B).