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67歳,男性。排尿障害を主訴に受診。前立腺特異抗原(PSA)は5.2 ng/mlであった。2か月後,激しい腰痛を覚えるようになり,骨シンチグラムで多発性異常集積が認められた。PSAは8.7 ng/mlで,前立腺および胸椎の生検では低分化腺癌であった。前立腺癌多発性骨転移と診断し,内分泌療法を施行した。その後は疼痛も消失し,PSAは0.2 ng/ml以下に低下したが,血清アルカリフォスファターゼ値は軽度高値であり,注意深い経過観察が必要である。
We report a case of progressive prostate cancer in the diagnostic gray zone of prostate specific antigen (PSA). A 67 year-old male with mild bladder outlet obstructive symptoms visited our clinic. At initial visit, he had no symptoms suggesting bone metastasis and his PSA level was 5.2 ng/ml. Two months later, he developed severe lumbago and MRI showed pathological compression fracture of the first lumbar spine. The PSA level was 8.7 ng/ml. Bone scintigram suggested multiple bone metas-tases. Biopsy specimens of the prostate and thoracic vertebra showed poorly differentiated adenocarcinoma. We treated him with endocrine therapy.
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