|Title||Clinical features of neuroendocrine prostate cancer.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Conteduca V, Oromendia C, Eng KW, Bareja R, Sigouros M, Molina A, Faltas BM, Sboner A, Mosquera JMiguel, Elemento O, Nanus DM, Tagawa ST, Ballman KV, Beltran H|
|Journal||Eur J Cancer|
|Date Published||2019 11|
|Keywords||Adenocarcinoma, Aged, Biopsy, Carcinoma, Neuroendocrine, Carcinoma, Small Cell, Cohort Studies, Disease Progression, Humans, Male, Middle Aged, Neoplasm Metastasis, Prognosis, Prostatic Neoplasms, Retrospective Studies, Survival Analysis, Treatment Outcome|
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.
|Alternate Journal||Eur. J. Cancer|
|PubMed Central ID||PMC6803064|
|Grant List||P50 CA090381 / CA / NCI NIH HHS / United States |
P50 CA211024 / CA / NCI NIH HHS / United States
R01 CA194547 / CA / NCI NIH HHS / United States
U24 CA210989 / CA / NCI NIH HHS / United States