Zusammenfassung
Duktale Adenokarzinome sind eine seltene Entität des Prostatakarzinoms. Die fehlende Korrelation des PSA-Wertes mit dem Tumorstadium sowie die rasche Metastasierungsfähigkeit mit einem schlechteren Outcome sind wesentliche Unterschiede zum azinären Adenokarzinom. Die Diagnostik erfolgt meist in fortgeschrittenen Stadien, da Frühsymptome oft fehlen. Klinisch führen die obstruktive Miktionssymptomatik und Hämaturie zum Arztbesuch. Die rektale Untersuchung kann dabei falsch-negative Befunde liefern, da das Tumorwachstum bevorzugt Richtung Colliculus seminales erfolgt. Bei fehlenden Behandlungsguidelines wird meist ein radikales operatives Vorgehen empfohlen. Therapieansätze reichen von radikaler Prostatektomie über die transurethrale Resektion bis hin zur hochdosierten Radiatio. Die anschließende Androgendeprivation wird empfohlen. Wir beschreiben den Fall eines 64-jährigen Patienten mit duktalem Adenokarzinom, der mittels radikaler Zystektomie und anschließender Androgenblockade erfolgreich behandelt wurde. Dies ist der erste beschriebene Fall in der deutsch-/englischsprachigen Literatur.
Abstract
Ductal adenocarcinoma of the prostate is a rare entity. The lack of correlation between the prostate-specific antigen value and the tumor stage, as well as early dissemination, are major differences from acinar cancer. Due to a lack of early symptoms, the tumor is often found in an advanced stage. Urinary obstruction and hematuria lead to clinical assessment. The characteristic tumor growth near the seminal colliculus can yield a negative digital rectal examination. Despite a lack of treatment guidelines, authors recommend an aggressive surgical concept. First approaches include radical prostatectomy, transurethral resection, and high-dose radiotherapy. Subsequent androgen deprivation is recommended. We report the case of a 64-year-old man with ductal prostate cancer who underwent radical cystectomy followed by androgen deprivation therapy. This is the first such case reported in both the German and the English literature.
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Brock, M., Martin, W., Sommerer, F. et al. Das duktale Adenokarzinom der Prostata mit Blasenhalsinfiltration. Urologe 48, 770–773 (2009). https://doi.org/10.1007/s00120-009-1968-6
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DOI: https://doi.org/10.1007/s00120-009-1968-6