[Neuroendocrine differentiation in prostate neoplasms. German version]

Area of Science:

• Oncology
• Endocrinology
• Cell Biology

Context:

• Neuroendocrine (NE) cells are present in the normal prostate and prostate adenocarcinomas.
• These cells influence prostate gland growth via paracrine signaling but lack proliferative activity and androgen receptors (AR).
• Prostate tumors with NE differentiation are categorized into five groups, with varying clinical significance.

Purpose:

• To classify and describe the spectrum of neuroendocrine prostate tumors.
• To highlight the clinical relevance of aggressive NE prostate carcinomas, including small cell NE carcinomas (SCNEC) and large cell NE carcinomas (LCNEC).
• To introduce therapy-associated neuroendocrine prostate cancer (t-NEPC) as a distinct entity.

Summary:

• Prostate NE tumors range from partial differentiation in adenocarcinomas to rare carcinoids (NETs) and aggressive SCNECs and LCNECs.
• t-NEPC, a new WHO classification, emerges from androgen deprivation, characterized by AR loss and high proliferation.
• Aggressive NE prostate carcinomas, including t-NEPC, necessitate prompt and intensive treatment strategies.

Impact:

• Distinguishing between different types of NE prostate cancer is crucial for appropriate patient management.
• The recognition of t-NEPC underscores the need for vigilant monitoring and potential re-biopsy in castration-resistant prostate cancer.
• Understanding NE prostate cancer subtypes informs therapeutic decisions and prognostic assessments for improved patient outcomes.