I am 78 and was diagnosed with prostate cancer (Gleason 9) with neuroendocrine differentiation. Does anyone have information on neuroendocrine prostate cancer, or has anyone had this type of prostate cancer, or can point me to someone who has. I've been told it is very rare. Thanks for your help.
Chuck
Hi Chuck,
Neuroendocrine cells exist in small numbers, scattered through the normal prostate.
Neuroendocrine differentiation generally means that a PCa tumor contains such cells, singly or in small groups. The cells lack an androgen receptor, so do not respond to androgen deprivation treatment [ADT] & do not produce PSA.
Neuroendocrine differentiation can emerge as a result of ADT.
As perhaps the "endocrine" part of the name suggests, neuroendocrine cells can secrete substances that can affect the growth rate of surrounding cells. Neuroendocrine cells do not normally proliferate, but in a tumor, play a supportive role in proliferation.
(My understanding.)
-Patrick
Thank you very for your informative response. I am taking Lupron as my doctor is trying to control the adenocarcinoma (Gleason 9). My PSA is now non-detectable. It was 2.8 when my cancer was discovered. I guess I'll double check with him about the ADT increasing the neuroendocrine differentiation. When my prostate cancer was first discovered it had focal neuroendocrine differentiation. All this is still somewhat confusing to me.
Chuck
Hi Chuck,
My point about ADT was that for most who develop neuroendocrine differentiation, it happens as a response to ADT. That's not your case.
Good news about your PSA - I wouldn't be concerned about ADT inducing neuroendocrine differentiation, since you already have some.
My reading of the literature is that the prognostic value of finding focal neuroendocrine differentiation is colored by the fact that it is usually detected in CRPC. But a 1998 study of core needle biopsies found that:
"... focal neuroendocrine differentiation failed to provide prognostic information ..."
"... focal neuroendocrine differentiation is not a prognostic factor in core needle biopsies of prostate cancer."
You might want to ask your doctor how focal neuroendocrine differentiation will affect his treatment of you. & perhaps investigate whether there are other doctors who are known for their work in this area.
-Patrick
Neuroendocrine prostate cancer is usually thought of as a rare type of prostate cancer, but recent understanding is that it is possible that at least 30% of all advanced prostate cancer has some of this type of cancer mixed in it at the cellular level. It is characterized as being very aggressive while also not making much PSA which is the hallmark of the other phenotypes.
Neuroendocrine Prostate Cancer does not usually respond well or for long periods of time to the traditional hormone therapies used to treat prostate cancer. Experienced, flexible clinicians have been using platinum-based chemotherapy agents either instead of or along with the traditional taxane based agents (docetaxel and Jevtana).
There are a few clinical trials that are currently recruiting evaluating specific treatment for this type of disease. I would recommend that you search out one of these trials for your treatment. Go to: clinicaltrials.gov and search for the trials for neuroendocrine prostate cancer.
Joel
Medical Oncologists specializing in neuroendocrine prostate cancer (or advanced and rare prostate cancer)?
Neuroendocrine prostate cancer
neuroendocrine tumors
Neuroendocrine 
