Clinical and therapeutic implications of neuroendocrine prostate cancer: a long winding road to cure
Chia-Lung Tsai、Kevin Lu、Hua-Pin Wang、Victor Chia-Hsiang Lin、Tsan-Jung Yu
Division of Urology, Department of Surgery, E-Da Hospital; School of Medicine, I-Shou University, Kaohsiung city, Taiwan
Introduction and objective:
Primary neuroendocrine cancer of prostate is an extremely rare variant of prostate cancer, comprising 0.5% to 2% of prostate malignancies. This entity encompasses various clinical contexts, ranging from the de novo small cell carcinoma (SCC) to a treatment-emergent transformed phenotype that arising from typical adenocarcinoma (Ad) of the prostate. The rarity of these neoplasms poses a diagnostic and therapeutic challenge. Little is known about neuroendocrine prostate cancer and the current knowledge of this disease is based on case reports or small series. Our purpose was to characterize the cases treated at a tertiary academic center and to evaluate patient outcomes with the available treatment modalities.
Material and Methods
This was a single-institute retrospective observational cohort study of patients with neuroendocrine prostate cancer followed at E-Da Hospital, Kaohsiung city, Taiwan between January 1, 2008 and October 1, 2013. Patient and tumor data were analyzed using descriptive statistical methods.
Results
Among 826 prostate cancers, six patients were identified with primary neuroendocrine prostate cancer, comprising 3 from de novo mixed variety (SCC and Ad) and 3 from transformed phenotype (pure SCC). The median age at diagnosis was 73.5 years. The most common presenting symptoms were obstructive symptoms (weak stream, incomplete empty and urine retention). The morphological appearance of the tumor cells and their immunohistochemical reactivity for neuroendocrine markers, and prostate specific antigen (PSA) helped establish the diagnosis. Overall median survival was 12 months from diagnosis of neuroendocrine prostate cancer/prostate small cell carcinoma
Conclusion:
Primary neuroendocrine prostate cancer is characterized by an aggressive clinical course with relatively short lifespan. Although high response rate to cytotoxic chemotherapy, overall prognosis is poor. As there is no standard of care for patients with neuroendocrine prostate cancer, further efforts should be directed at its early detection and made to develop more effective therapeutic strategy