Commentary - Journal of Molecular Oncology Research (2022) Volume 6, Issue 5
A case of urethral metastasis of castration-resistant prostate cancer effectively cured with radiosurgery.
Department of Urology, University of Yamanashi, Yamanashi, Japan
- *Corresponding Author:
- Norifumi Sawada
Department of Urology
University of Yamanashi
E-mail: [email protected]
Received: 25-Apr-2022, Manuscript No. AAMOR-22-62601; Editor assigned: 27-Apr-2022, Pre QC No. AAMOR-22-62601(PQ); Reviewed: 11-May-2022, QC No. AAMOR-22-62601; Revised: 17-May-2022; AAMOR-22-62601(R); Published: 24-May-2022, DOI: 10.35841/aamor-6.5.124
Citation: Sawada N. A case of urethral metastasis of castration-resistant prostate cancer effectively cured with radiosurgery. J Mol Oncol Res. 2022;6(5):124
Removed urethral metastasis of the castration-resistant prostate cancer (CRPC) is exceptionally uncommon. In this case report, we display a 69-year-old man who was to begin with analyzed prostate cancer from the sessile papillary tumor within the prostatic urethra which repeated after surgery and androgen hardship treatment and at long last treated with CyberKnife radiosurgery. There has been no repeat for 50 months. To the most excellent of our information, there's no case of urethral metastasis of the CRPC effectively controlled with CyberKnife radiosurgery within the writing.
Castration-resistant prostate cancer, Urethral metastasis, CyberKnife radiosurgery.
The common locales of the metastasis being bone, lung, liver, and brain, far off urethral metastasis of the prostate cancer is exceptionally rare. The treatment of urethral metastasis as a rule presents destitute guess and it has clinical esteem to report a controlled case with modern methodology. We display a case of urethral metastasis within the front urethra of castration-resistant prostate cancer (CRPC) 12 months after radical prostatectomy treated with CyberKnife radiosurgery. A 69-year-old male understanding was alluded to our clinic since of macrohematuria. His introductory prostate-specificantigen (PSA) level was 9.598 ng/mL, and computerized rectal examination demonstrated a difficult mass which was suspected to be a neighborhood progressed prostate cancer. Cystoscopy uncovered a sessile papillary tumor knob within the back urethra close verumontanum. Transurethral resection of the tumor and transrectal ultrasound (TRUS) guided prostate biopsy were performed. Urethral tumor appeared Gleason 4 + 4 prostatic adenocarcinoma and TRUS prostate biopsy affirmed Gleason Score 5 + 4 adenocarcinoma in 4 out of 8 biopsy cores. Due to the abnormal introduction of the urethral tumor, immunostaining was performed and appeared solid PSA inspiration. Organizing computed tomography (CT) check affirmed a locally progressed prostatic tumor. A radioisotope bone scintigraphy appeared no bone metastasis. The understanding had experienced radical retropubic prostatectomy and amplified lymphadenectomy . Neurotic examination uncovered two masses of Gleason Score 4 + 4 adenocarcinoma with additional prostatic expansion. The surgery was uneventful and serum PSA went down to 2.640 ng/mL. Twelve months after surgery, serum PSA emerges, and cystoscopy uncovered urethral tumor within the front urethra. Cold container biopsy of the tumor was performed and it appeared Gleason Review 4 + 4 adenocarcinoma with positive PSA recoloring. Androgen hardship treatment was started and the backslid tumor vanished in 3 months. After 6 months of androgen hardship treatment, he had another chance of macrohematuria and PSA height. Cystoscopy once more uncovered a backslide of urethral tumor analyzed as CRPC due to the moo testosterone esteem. MRI appeared a tumor within the front urethra . Shared choice making was done with the quiet. The quiet did not anticipate any advance surgical treatment and chosen to experience Cyber Knife radiotherapy of 7.25 Gy × 5 times. The tumor had vanished and serum PSA esteem diminished to <0.003 ng/mL. Cystoscopy and MRI were performed each 6 months and he is as of now clinically steady for 50 months. There had been no extreme comorbidity other than a few chances of minuscule hematuria. Essential penile urethral cancer is exceptionally uncommon and metastatic tumors are indeed less visit. The beginning is as a rule the bladder, prostate, or the gastrointestinal framework. Ellis and Epstein checked on 29 cases of metastatic prostate cancers to the penis, found 16 (55.2%) of them had started from prostatic ductal adenocarcinomas and most of the leftover portion started in acinar adenocarcinomas.
Our case has highlights of tall review prostatic acinar adenocarcinoma. Metastases from prostate cancer to the urethra appear a number of structural designs counting papillary, cribriform, single organs. The primary visual conclusion in our case was essential urethral cancer of urothelial root, so that immunostaining was performed to affirm the genuine nature of the tumor. Urothelial and prostate cancers takes after morphologically, and a few of the ineffectively separated prostate adenocarcinomas has negative PSA immunostaining. In our case, the PSA recoloring was unequivocally positive in each tissue so that we seem analyze as prostate cancer metastasize to urethra .
The instrument of the spread to the urethra is still hazy and there's no single clear clarification since of the complex structure of the urethra. The instrument has been talked about to incorporate 4 designs, such as implantation by instrumented, blood vessel emboli, coordinate intrusion, and venous or lymphatic dispersal in a retrograde way Comparing the histology of our case some time recently and after radical prostatectomy as appeared , it appears that implantation amid surgery may well be the causative in our case . To attain the healing treatment, we ought to have advocate add up to cyst prostatectomy and urethrectomy. The frequency of essential urethral cancer is exceptionally and the metastatic one is indeed lower. In localized essential urethral cancer, total urethrectomy with encompassing tissue is exhorted to play down repeat due to positive margins. Amid the radical prostatectomy, the prostatic urethra was totally expelled but the pathology detailed an injury of extraprostatic expansion around one of the prostate cancer mass and vein invasion of the cancer. The backslid tumor happened 6 months after surgery within the penile urethra which was fair close the vesicourethral anastomosis injury. Those come about demonstrate venous spread and implantation amid surgery. Patients with metastatic prostate cancer to the urethra for the most part have a destitute guess since they are ordinarily analyzed in progressed stages. In this displayed case, add up to cyst prostatectomy and urethrectomy might have been a candidate for the corrective treatment, be that as it may, it might be intrusive. CyberKnife treatment was performed with no antagonistic impacts and there had been no serious comorbidity, in this manner, it has been shown that CyberKnife radiosurgery can be an successful treatment choice for the urethral metastasis of CRPC .
- Gandaglia G, Abdollah F, Schiffmann J, et al. Distribution of metastatic sites in patients with prostate cancer: A population-based analysis. Prostate. 2014;74(2):210-16.
- Ellis CL, Epstein JI. Metastatic prostate adenocarcinoma to the penis: A series of 29 cases with predilection for ductal adenocarcinoma. Am J Surg Pathol. 2015;39(1):67-74.
- Rao MS, Bapna BC, Bhat VN, et al. Multiple urethral metastases from prostatic carcinoma causing urinary retention. Urol.1977;10(6):566-67.
- Taylor GB, McNeal JE, Cohen RJ, et al. Intraductal carcinoma of the prostate metastatic to the penile urethra: A rare demonstration of two morphologic patterns of tumor growth. Pathol. 1998;30(2):218-21.
- Janisch F, Abufaraj M, Fajkovic H, et al. Current disease management of primary urethral carcinoma. Eur Urol Focus. 2019;5(5):722-34.