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[Neuroendocrine prostate cancer].

S Tritschler1, R Erdelkamp2, C Stief3

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Der Urologe. Ausg. A
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Summary

Neuroendocrine prostate cancer (NEPC) arises from androgen deprivation treatment. Suspect NEPC in aggressive metastatic castration-resistant prostate cancer (mCRPC) with low PSA and elevated neuroendocrine markers.

Keywords:
Androgen deprivation therapyChemotherapyChromogranin ANeuroendocrine carcinomaProstate

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Area of Science:

  • Urology
  • Oncology
  • Cancer Biology

Background:

  • Neuroendocrine prostate cancer (NEPC) often emerges as a treatment-adaptive response to androgen deprivation therapy (ADT) in metastatic castration-resistant prostate cancer (mCRPC).
  • Approximately 30-40% of mCRPC cases exhibit neuroendocrine differentiation, while primary small cell prostate cancer is rare (<1%).
  • High Gleason score is an independent risk factor for developing treatment-emergent NEPC (t-NEPC).

Purpose of the Study:

  • To outline the clinical suspicion, diagnostic indicators, and treatment strategies for neuroendocrine prostate cancer.
  • To differentiate t-NEPC from primary small cell prostate cancer.
  • To guide therapeutic decisions based on prostate-specific antigen (PSA) levels in NEPC patients.

Main Methods:

  • Clinical suspicion criteria for t-NEPC include aggressive mCRPC with disproportionately low PSA and elevated neuroendocrine markers (chromogranin A, neuron-specific enolase).
  • Correlation analysis of initial Gleason score with t-NEPC development risk.
  • Review of treatment protocols, including chemotherapy regimens for NEPC based on PSA levels.

Main Results:

  • Chemotherapy with cisplatin and etoposide yields 30-60% response rates and <1 year median survival in PSA-negative NEPC.
  • Carboplatin plus docetaxel is considered for NEPC patients with significantly elevated serum PSA levels.
  • Initial Gleason score is a significant predictor for t-NEPC development.

Conclusions:

  • NEPC requires high clinical suspicion in mCRPC patients presenting with aggressive disease, low PSA, and elevated neuroendocrine markers.
  • Treatment approaches for NEPC are adapted from small cell lung cancer protocols, with specific chemotherapy choices dependent on PSA levels.
  • Early identification and appropriate treatment selection are crucial for managing NEPC, given its aggressive nature and distinct therapeutic requirements.