title: Chemotherapy with Gemcitabine and Cisplatin for Advanced Ductal Adenocarcinoma of the Prostate: Clinical Courses of Two Patients.
abstract: Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate with a poorly understood natural history, and its treatment is not well defined. Ductal adenocarcinoma is often diagnosed at an advanced stage, because no specific tumor markers are known. Docetaxel has been used for acinar adenocarcinoma of the prostate, a common type of prostate cancer, but it is largely ineffective for ductal adenocarcinoma. Earlier studies suggested that the chemotherapy with gemcitabine and cisplatin might be effective for ductal adenocarcinoma. Here we report two patients with ductal adenocarcinoma of the prostate that did not respond to docetaxel, but responded to the gemcitabine/cisplatin chemotherapy. Patient 1 was a 59-year-old man who had lung metastasis despite androgen deprivation therapy with undetectable levels of prostate-specific antigen and who presented with brain metastasis during docetaxel chemotherapy. Pathological examination of the resected brain tumor revealed ductal adenocarcinoma with positive immunostaining for carcinoembryonic antigen. The gemcitabine/cisplatin chemotherapy achieved partial response of the lung metastasis with serum carcinoembryonic antigen levels decreasing from 11.4 ng/mL to 2.9 ng/mL. Patient 2 was a 69-year-old man with lung metastasis. Local progression appeared during androgen deprivation therapy, and the subsequent transurethral biopsy revealed ductal adenocarcinoma with positive immunostaining for neuron-specific enolase. Bone and distant lymph node metastasis appeared despite docetaxel chemotherapy. Six courses of the gemcitabine/cisplatin chemotherapy achieved partial response of metastatic lesions, with serum neuron-specific enolase levels decreasing from 118 ng/mL to 2.6 ng/mL. The gemcitabine/cisplatin chemotherapy is a potential option for treatment of advanced ductal adenocarcinoma of the prostate.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawamorita
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Yamada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Haruo
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D002272:Carcinoembryonic Antigen; D003841:Deoxycytidine; D010751:Phosphopyruvate Hydratase; D002945:Cisplatin; D000093542:Gemcitabine