以間歇性非典型腰痛表現之攝護腺癌合併多處骨轉移--個案報告

Prostate Cancer with Multiple Bone Metastases Presenting as Intermittent Flank Pain: A Case Report

一名有腎結石病史的55歲男性，約2週前開始出現騎摩托車時震動引起雙側間歇性腰痛而至家庭醫學科門診就診。尿液分析無異常，腹部X光(KUB)沿著泌尿系統的區域也沒有結石影像。但意外發現雙側髂骨以及側面腰薦椎X光多處腰椎椎體呈現成骨性病灶。因合併prostate-specific antigen)升高，在高度懷疑攝護腺癌合併多處骨轉移之下，個案轉診至泌尿科進一步檢查，經直腸超音波導引攝護腺切片和骨骼掃描確診為攝護腺癌合併多處骨轉移。

本文總結了有關腰痛鑑別診斷和攝護腺癌骨轉移表現的文獻。由於腰痛是基層醫業常見的主訴，本病例報告應有助於提醒基層醫師，非典型腰痛病人應考慮可能致命的攝護腺癌骨轉移，尤其是合併出現任何危險信號的中年男性。

 

We reported a 55-year-old man with a history of renal stone who experienced for two weeks intermittent bilateral flank pain, which was precipitated by vibration when riding a motorcycle. He later went to a family medicine department for further examination. Urinary analysis showed no specific finding, and the KUB disclosed no radiopaque along the supposed urinary territory. However, numerous osteoblastic lesions at bilateral iliac bone and multiple lumbar vertebral bodies were accidentally found on the X-ray of the lumbosacral spine lateral view. Due to an elevated prostate-specific antigen level, he was referred to the urological department. Prostate cancer with multiple bone metastases was first suspected and later diagnosed by transrectal ultrasound guided prostate biopsy and bone scan.

The literature on differential diagnosis of flank pain and presentation of prostate cancer with bone metastasis were reviewed herein. Because flank pain is a common complaint in primary care, this case report should help remind primary physicians to consider the potentially fatal prostate cancer with bone metastasis for patients with atypical flank pain, especially for middle-aged patients complicated with red flag signs.