中部尿管にまで及ぶ広範な浸潤をきたした前立腺癌の1例

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69歳男.検診でPSA高値(16.4ng/ml)とエコー上右水腎症を指摘され精査入院となった.腹部骨盤CTで中部～下部にかけての尿管壁の肥厚を認め,また,右骨盤内にリンパ節腫大を認めた.MRIでは前立腺右葉に腫瘤像を認め,腫瘤は前立腺から膀胱,右尿管口,さらには大動脈分岐部付近の尿管まで連続的に浸潤していた.逆行性腎盂造影では右腎盂尿管移行部以下の全体的な尿管の狭窄を認めた.前立腺生検の結果はAdenocarcinoma,poorly differentiated,Gleason score 5+4,臨床病期はT4N1M1b stage D2であった.ビカルタミド+酢酸リュープロレリン+CDDP+THPの化学内分泌療法を開始し,3コース終了後のPSA値は0.1ng/mlと正常化,MRI上もリンパ節の縮小が認められたが,尿管浸潤像にはあまり変化がみられなかったA 69-year-old male was diagnosed as having prostate cancer with ureter invasion. His serum prostate specific antigen level was not so high (19.6 ng/ml) before treatment, but clinical stage was D2, poorly differentiated adenocarcinoma of prostate. He was treated with chemoendocrine therapy. Prostate cancer with continuous invasion to the middle ureter is rare. To the best of our knowledge, this is the 6th case report of such an unusual invasion of prostate cancer.