Clinical Features of Neuroendocrine Prostate Cancer

[Balsam01]

TAKE-HOME MESSAGE

•This retrospective study was designed to describe the clinical features of neuroendocrine prostate cancer. Cases were characterized by low PSA levels and a high frequency of visceral metastases. Small-cell carcinoma of the prostate was associated with significantly worse overall survival than mixed-histology disease.

•These characteristics of neuroendocrine prostate cancer may aid future diagnosis and management of the disease.

– Neil Majithia, MD

Background

Neuroendocrine prostate cancer (NEPC) is an aggressive variant of prostate cancer that may arise de novo or in patients previously treated with hormonal therapies for prostate adenocarcinoma as a mechanism of resistance. Despite being important to recognise, the clinical features of NEPC are poorly defined and could help guide when to perform a biopsy to look for NEPC histologic transformation.

Methods

We reviewed baseline, treatment and outcome data of 87 patients with metastatic prostate cancer and tumour biopsy confirming NEPC histology. Forty-seven (54.0%) NEPC cases presented de novo, and 40 (46.0%) were therapy-related (t-NEPC). Thirty-six (41.4%) were classified as pure small-cell carcinoma, and 51 (58.6%) demonstrated mixed features with both small-cell carcinoma and adenocarcinoma present. Genomic data were available for 47 patients.

Results

The median age at time of NEPC was 68.1 years, median prostate-specific antigen (PSA) was 1.20 ng/ml (0.14 ng/mL small-cell carcinoma, 1.55 ng/mL mixed carcinoma) and sites of metastases included bone (72.6%), lymph node (47.0%), and viscera (65.5%). Median time from adenocarcinoma to t-NEPC diagnosis was 39.7 months (range, 24.5–93.8) with a median of two lines of prior systemic therapy. Platinum chemotherapy was used to treat 57.5% of patients, with a median progression-free survival of 3.9 months. Small-cell carcinoma was associated with worse overall survival (OS) than mixed histology (8.9 months from NEPC diagnosis versus 26.1 months, P < 0.001). Median OS of de novo NEPC was shorter than that of t-NEPC (16.8 months from prostate cancer diagnosis versus 53.5 months, P = 0.043). An average PSA rise per month of ≤0.7 ng/ml before t-NEPC; elevated lactate dehydrogenase levels, RB1 and TP53 loss and liver metastases were poor prognostic features.

Conclusions

We describe the clinical features of a cohort of patients with NEPC. These characteristics may inform future diagnostic strategies.

European Journal of Cancer

Clinical Features of Neuroendocrine Prostate Cancer

Eur. J. Cancer 2019 Nov 01;121(xx)7-18, V Conteduca

[DenDoc]

Nice to see some data. I am one of those described with a hybrid tumor. Carboplatin seems to have stopped the small cell cancer from growing for now. Adenocarcinoma responding to Enzalutamide.