Clinical Information Of The Patients Reported In Literatures
The 26 cases were aged from 21 to 82 years . Because the median age was 61 years, patients were divided into two groups: < 59 years old and 60 years old. There were 15 cases in the 60 group . Most cases suffered from difficulty urinating, and 20 cases showed normal serum PSA levels. DRE indicated grade III prostate enlargement and hardening. Space-occupying lesions were detected by imaging examinations. Among them, 11 cases underwent prostate biopsies eight underwent transurethral resection of the prostate and seven underwent radical prostatectomy. For postoperative treatment, 13 cases received chemotherapy, two received radiotherapy, and 13 had a history of endocrine therapy .
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Recalcitrant Cancer Research Act
In 2013, the US Congress passed the Recalcitrant Cancer Research Act, which mandated increased attention to certain recalcitrant cancers, including small cell lung cancer. That led to the National Cancer Institute supporting small cellspecific research through a consortium.
As a result, new experimental drugs for small cell lung cancer are currently being tested, including Iadademstat and Keytruda .
Transitional Cell Prostate Cancer
This is also known as urothelial carcinoma. This cancer starts in the cells that line the urethra .
Studies of men with transitional cell prostate cancer show that PSA levels can be low or high. More research is needed before we can know whether PSA tests can help to diagnose transitional cell prostate cancer.
Men with this cancer often have difficulty urinating and find blood in their urine. This is because the cancer grows around the urethra , causing it to narrow. So transitional cell carcinoma is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have transitional cell prostate cancer. Youll also need scans to see if your cancer has spread.
If the cancer has not spread outside the prostate , then you may be offered surgery and radiotherapy.
If the cancer has spread to areas just outside the prostate or to more distant areas of the body such as the bones then chemotherapy and radiotherapy may be an option.
In the UK, docetaxel is the standard chemotherapy drug for men with advanced prostate cancer that is no longer responding to hormone therapy. But if you have transitional cell prostate cancer you may have other types of chemotherapy, called carboplatin or cisplatin chemotherapy. If you have cisplatin chemotherapy, you will probably have it alongside another chemotherapy drug called gemcitabine.
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Metastatic Small Cell Carcinoma Of The Prostate In An Octogenarian With Significant Response To First
Anthony Wood
Division of Hematology & Medical Oncology Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
E-mail :
Nabil Adra
Division of Hematology & Medical Oncology Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
Liang Cheng
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
Roberto Pili
Division of Hematology & Medical Oncology Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
DOI: 10.15761/HMO.1000120
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Basal Cell Prostate Cancer
You might also hear this called adenoid cystic prostate cancer or basaloid carcinoma. Men who have basal cell prostate cancer can also have common prostate cancer at the same time. We dont know how aggressive it is. Some studies suggest it isnt very aggressive. But other studies suggest it might be more aggressive than common prostate cancer.
Basal cells dont produce PSA, and most men with basal cell prostate cancer have normal levels of PSA in their blood. This means that a PSA test probably wont help to diagnose basal cell prostate cancer.
Basal cell cancer can grow big enough to cause the urethra to narrow, this can cause difficulty urinating. So basal cell prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have basal cell prostate cancer. You will also have scans to see if your cancer has spread.
Your treatment options will depend on how much the cancer has grown and whether it has spread to other parts of the body. You may be offered:
- or a combination of these treatments.
Your doctor or nurse will tell you what treatment options are available to you.
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of lung cancer is 60%, it means that people who have that cancer are, on average, about 60% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed.
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for non-small cell lung cancer and small cell lung cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the lung.
- Regional: The cancer has spread outside the lung to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body, such as the brain, bones, liver, or the other lung.
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Diagnosing Rare Prostate Cancers
Rarer prostate cancers can be harder to diagnose. For example, some dont cause your prostate specific antigen level to rise. This means theyre not always picked up by a PSA test. Because of this, some rare cancers may not be diagnosed until they have already spread outside the prostate. Read more about the PSA test and other tests used to diagnose prostate cancer.
Some rare prostate cancers may only be picked up after having a biopsy to check for prostate cancer, or surgery called transurethral resection of the prostate to treat an enlarged prostate. The tissue removed during the biopsy or TURP is looked under a microscope to see if you have common prostate cancer or a rare type of prostate cancer. Rare cancers arent always given a Gleason score after a biopsy. This is because they can behave differently to common prostate cancer and cant be measured in the same way.
Because rare cancer can be aggressive and spread outside the prostate, you will probably have more tests to see if they have spread. These include:
Small Cell Prostate Cancer
Small cell prostate cancer is a rare type of prostate cancer. Less than 2 in every 100 prostate cancers are small cell prostate cancer. They can also be classed as a type of neuroendocrine prostate cancer.
Small cell prostate cancers are very different from the most common type of prostate cancer. They grow more quickly than other types. Most people with small cell prostate cancer have advanced cancer by the time they are diagnosed. This means that the cancer has spread to other parts of the body such as the bones.
The most common symptoms of small cell prostate cancer include:
- difficulty passing urine
You may also have a group of symptoms called paraneoplastic syndrome. This is when you have high levels of certain hormones in the body. Symptoms of paraneoplastic syndrome include:
- pricking, tingling or numbness in your arms, hands, legs and feet
- difficulty swallowing
- problems with your memory
Small cell prostate cancer develops from neuroendocrine cells of the prostate. These types of cells dont make prostate specific antigen . So the PSA level in men with small cell prostate cancer is often normal, or only slightly higher than normal. This is different from people with more common types of prostate cancer.
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Patient And Disease Variables
In our study cohort, the median age at diagnosis was 70 6276) . Survival data were available for 197 patients with a median follow-up time of 14 months and a total of 158 deaths. A majority of patients were white , lived in a metropolitan area and received treatment at a comprehensive cancer program . The year of diagnosis and region of diagnosis were evenly distributed across the study period. For patients with known CCI, the majority had CCI of 0 . Of the patients diagnosed after 2003, the median PSA was 4.9ngml1 and 61% presented with elevated measurements . Among men with recorded clinical T stage, 73% were staged cT12.
Table 1 Patient, hospital and clinical characteristics
Does Atezolizumab Boost Survival With Chemotherapy In Small Cell Or Neuroendocrine Carcinoma Of The Prostate
A correlation between small cell or neuroendocrine carcinoma of the prostate and poor survival outcomes was revealed, despite treatment with the combination of the immunotherapy agent atezolizumab and chemotherapy, according to an institutional study conducted within the Mayo Clinic.
A correlation between small cell or neuroendocrine carcinoma of the prostate and poor survival outcomes was revealed, despite treatment with the combination of the immunotherapy agent atezolizumab and chemotherapy, according to an institutional study conducted within the Mayo Clinics Division of Medical Oncology.
The exploration of this combination in prostate cancer was influenced by the survival benefit observed with atezolizumab and chemotherapy in patients with extensive-stage small cell lung cancer . It is a common clinical practice to use regimens from the SCLC space to treat rare extrapulmonary small cell carcinoma, therefore oncologists at the Mayo Clinic sought to test the treatment strategy in their institution.
Recent introduction of checkpoint inhibitor therapy for SCC of the prostate was based on extrapolation from studies in small-cell lung cancer. We wanted to review the outcomes for such patients who had received chemo-immunotherapy treatment at Mayo Clinic, the study lead Lance C. Pagliaro, MD, professor of oncology, Division of Medical Oncology, Department of Oncology at Mayo Clinic, told Targeted Oncology in an interview.
Reference:
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Genomic And Molecular Characteristics Of Nepc
It has been known that aberrant Rb and p53 pathways play important roles in NEPC trans-differentiation, since TRAMP model with deficient Rb and Trp53 due to SV40 large T antigen expression leads to the formation of aggressive tumors with NE features . Aberrations in the Rb and p53 pathways are also observed in small cell lung cancer . The first comprehensive evaluation of the status of Rb, p53, and PTEN in human prostatic SCC showed that loss of Rb protein is a common event as revealed by a validated IHC assay. In contrast, only 7% of primary high-grade acinar carcinomas showed Rb protein loss. Moreover, loss of PTEN and accumulation of p53 were observed in 63% and 56% of SCC cases, respectively. Of the SCC cases for which copy number analysis or sequencing were available, 85% showed RB1 allelic loss and 60% had TP53 mutation . Another study reported that compared to CRPC adenocarcinoma, NEPC displayed a lower frequency of AR somatic alterations and lower AR signaling , and a higher frequency of RB1 loss and TP53 alterations . After adjustment for the presence of liver metastasis, co-occurrence of RB1 loss and TP53 alterations was significantly associated with worsening of OS from the time of NEPC diagnosis .
Figure 1
Coping With Small Cell Prostate Cancer
Coping with a rare condition can be difficult, both practically and emotionally. Being well informed about the cancer and its treatment can help you to make decisions and cope with what happens. It can also help to talk to other people who have the same condition.
You can visit Cancer Chat Cancer Research UKs discussion forum. It is a place for anyone affected by cancer to share experiences, stories and information with other people who know what you are going through.
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Emergence Of The Neuroendocrine Subtype
Potent hormone therapies like abiraterone and enzalutamide can be effective treatments for men with castrate-resistant prostate cancer. However, almost all men eventually develop drug resistance to these agents.
In some cases, the drug-resistant cancer may look and behave differently than the original cancer, so much so that it is considered a different subtype of the disease. For example, some men who were originally diagnosed with adenocarcinoma prostate cancer develop t-SCNC after treatment with abiraterone or enzalutamide.
Under the microscope, t-SCNC looks quite different from adenocarcinoma: the cells are smaller and more crowded together. And compared to adenocarcinoma prostate tumors, tumors of the t-SCNC subtype are thought to have less hormone signaling and lower prostate-specific antigen.
In addition, t-SCNC shares some features with a small-cell neuroendocrine subtype of prostate cancer that appears in less than 1% of men with newly diagnosed prostate cancer.
To understand how frequently t-SCNC develops after hormone treatment, Dr. Aggarwal and his colleagues analyzed metastatic tumor samples from 202 men with castrate-resistant prostate cancer who had received treatment at multiple institutions. The samples were obtained from metastatic tumors in the bone, lymph nodes, liver, or other soft tissues.
The anatomical site where the metastatic tumor sample had been taken did not appear to affect the frequency of the neuroendocrine subtype, the researchers found.
Research Models Of Nepc
Suitable research models of NEPC are important to understand the biology of the disease and to develop effective therapies. Patient-derived xenografts , genetically engineered mouse models, cell lines, and organoids have been established as experimental models of NEPC. Although the number and variety of NEPC models is still not adequate to represent the diversity of NEPC, the number of available models is increasing in recent times.
Some researchers use PC3 or DU145 cells as alternatives to NEPC cell lines, because they do not express AR. PC3 cells are TP53-null and DU145 cells have TP53 mutations in addition to a loss of RB1. However, because these cell lines are not genuine NEPC models, care should be taken when using these cells as preclinical models of NEPC. NCI-H660 is the only widely used cell line of NEPC which originates from a patient with NEPC. In 1983, this cell line was initially established from a lymph node metastasis from autopsy samples of a patient with extra-pulmonary SCC . More than 10 years later, the discovery of the TMPRSS2-ERG fusion gene of NCI-H660 proved it to be a valuable NEPC model . The cell line is cultured as floating cells with cluster formation similar to many other small cell lung carcinoma cell lines.
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Signet Ring Cell Prostate Cancer
You might also hear this called signet cell prostate cancer or signet ring cell adenocarcinoma. Signet ring cell cancer can be very aggressive and spread to other parts of the body.
Like common prostate cancer, signet ring cell prostate cancer can produce high levels of PSA. This means a PSA test can be used to help diagnose signet ring cell prostate cancer. But a biopsy is needed to confirm it is a signet ring cell cancer.
If your biopsy shows that you have signet ring cell cancer, you may need further tests to check whether it started in your prostate or somewhere else. If your cancer started in another part of the body, it will affect the type of treatment you have. For example, if the cancer spread to the prostate from your stomach, you will be offered treatment for stomach cancer, not prostate cancer.
Your treatment will depend on how much the cancer has grown and whether it has spread to other parts of the body. You may be offered:
- or a combination of these treatments.
Your doctor or nurse will tell you what treatment options are available to you.
Diagnostic Challenge Of T
Although t-NEPC is typically diagnosed by metastatic biopsy, the disease is heterogenous and precise characterization of each case to recommend best treatment option is quite challenging. An unbiased hierarchical clustering of RNA sequencing data for 119 metastatic CRPC biopsy, which included 21 t-NEPC, identified a cluster enriched with t-NEPC . Quite interestingly, the cluster included six of 14 pure t-NEPC, two of seven tumors with mixed histology, and four of 90 tumors with pure adenocarcinoma. RB1 loss signature score was higher in the cluster compared to the other cluster, and AR transcriptional score was lower. The cluster was enriched with genes transcriptionally regulated by E2F1, ASCL1, FOXA2, and POU3F2, all of which are implicated in NEPC. The data suggests that histology, transcriptional profiling patten, and clinical prognosis do not link one-to-one. The study also showed that when histology and transcriptome data were combined, there was a greater separation of survival curves than either histologic or genomic analysis alone.
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Prostate Cancer With A Normal Psa: Small Cell Carcinoma Of The Prostate A Rare Entity
Pure small cell carcinoma of the prostate is extremely rare. When it does occur, it is usually in concordance with prostatic adenocarcinoma. Early diagnosis is difficult as the carcinoma tends to spread early to visceral organs without concordant elevation of prostate-specific antigen . Because this condition is rare, no standard treatment regimen has been established, and the overall prognosis remains poor.
This case report describes clinical characteristics of a 67-year-old man with pure small cell carcinoma of the prostate. The unique clinical and biological features of this histologic type of prostate cancer are discussed.