Small-cell carcinoma of prostate

doi:10.1016/0090-4295(89)90281-1

Urology

Volume 33, Issue 4, April 1989, Pages 332-335

https://doi.org/10.1016/0090-4295(89)90281-1 Get rights and content

Abstract

Small-cell carcinoma of the prostate is rare, but lethal. We report on 2 cases and review another 6 cases reported in the English literature. Microscopically the tumor may be pure small-cell carcinoma like that seen in the lung or may have a mixed pattern of adenocarcinoma with small-cell carcinoma. This tumor most probably arises from the basal or reserve cells of the prostatic acini. The totipotential basal cells have dual capacity for differentiation into adenocarcinoma and small-cell carcinoma.

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Citation Excerpt :
Nonetheless, such cases are very rare, which renders their analysis impossible, unless very large, population-based databases, such as the Surveillance, Epidemiology, and End Results (SEER) database, are used. Unfortunately, most reports on de-novo NEPC represent small sample-size series4-10 or case reports.11-24 Their denominator is insufficient for ascertainment of incidence figures or even survival data with reasonably narrow confidence intervals.
Neuroendocrine carcinoma of the prostate (NEPC) is a rare entity. We aimed at providing contemporary data on incidence and survival figures of de-novo NEPC.
Within the Surveillance, Epidemiology, and End Results (SEER) database, we identified 309 individuals with de-novo NEPC diagnosed between 2004 and 2013. We evaluated age-adjusted incidence rates over the study. Kaplan-Meier analyses assessed overall survival (OS) after stratification according to histologic subtype, metastatic status, and treatment. Cox regression analyses tested the predictors of overall mortality, after adjusting for confounders.
A total of 309 cases of NEPC were identified from 510,913 cases of prostate cancer. Metastatic disease was identified in 198 (64.1%) cases. The most common histologic subtype (n = 186; 60.2%) was small-cell carcinoma (SCC). The age-adjusted incidence of NEPC significantly increased over the study span. However, this increase only affected SCC (from 0.13/1,000,000 person-years in 2004 to 0.30/1,000,000 person-years in 2013; P = .001). Median survival for NEPC was 10 months. After stratification by metastatic status, no difference was observed according to SCC versus non-SCC. Treatment with radical prostatectomy improved OS only among individuals with non-metastatic disease, whereas radiation therapy did not affect OS rates. In multivariable Cox regression analyses predicting overall mortality, metastatic stage (hazard ratio, 1.52; 95% confidence interval, 1.12-2.06; P < .01) and radical prostatectomy (hazard ratio, 0.38; 95% confidence interval, 0.20-0.74; P < .01) achieved independent predictor status.
De-novo NEPC is extremely rare and will be encountered in clinical practice by few urologists. Most cases are metastatic at diagnosis. Prognosis is poor regardless of histologic type, especially in metastatic stage.
Unusual and Underappreciated: Small Cell Carcinoma of the Prostate
2007, Seminars in Oncology
In recent years, attention has focused on the prognostic importance of neuroendocrine differentiation in prostate cancer. Focal neuroendocrine differentiation in prostatic adenocarcinoma is a frequent finding. Though controversial, the prevalence of neuroendocrine cells has been correlated with higher-grade malignancy and poor prognosis. As with other small cell tumors, production of ectopic neuropeptides has been reported. The rarity of the disease has precluded prospective randomized trials. Therapeutic regimens have mainly been modeled after those for small cell lung carcinoma. Here we review the literature to identify potential diagnostic, therapeutic, and prognostic factors. Evident from this review is the necessity for further research in the biology of small cell carcinoma progression, in order to improve therapy.
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1998, Journal of Urology
We assessed the prognostic impact of genitourinary small cell carcinoma tumor and patient characteristics, and therapy.
We retrospectively reviewed the records of 180 patients with genitourinary small cell carcinoma in which patient and tumor characteristics, therapy, followup duration and survival status had been documented. Patient age, sex, primary site, histological features, tumor size, stage, locoregional therapy, systemic chemotherapy and hormonal manipulations were analyzed for association with survival.
There were 106 cases of bladder, 60 prostatic, 8 renal and 6 ureteral small cell carcinoma. Median survival was 10.5 months overall, and 7 and 13 months for prostatic and bladder small cell carcinoma, respectively (p <0.0001 log rank analysis). In all cases metastatic disease at presentation (p <0.008, risk ratio 1.9) predicted poor survival on multivariate analysis. Radical surgery (p <0.0001, risk ratio 0.34) and cisplatin chemotherapy (p <0.0001, risk ratio 0.20) were the only factors that predicted improved survival on multivariate analysis. For prostatic small cell carcinoma primary surgical therapy (p <0.012, risk ratio 0.46) was the only parameter that predicted survival on univariate analysis. For bladder small cell carcinoma only cisplatin chemotherapy (p <0.0001, risk ratio 0.15) predicted survival on multivariate analysis.
Genitourinary small cell carcinoma has a poor prognosis, which is worse in prostatic than bladder disease. Patient and tumor characteristics were not determinants of survival when prostatic and bladder small cell carcinoma were analyzed individually. For prostatic disease only primary surgical therapy was associated with prolonged survival, while for bladder disease cisplatin chemotherapy was associated with a favorable prognosis. We recommend considering primary surgical therapy for prostatic and cisplatin based chemotherapy for bladder small cell carcinoma.
Small cell carcinoma of the bladder and prostate
1995, Urology
Unusual primary prostatic malignancies
1992, Urology
Atypical prostatic cancer is defined as any malignancy of prostatic origin. excluding the common acinar prostatic adenocarcinoma. These atypical prostate cancers account for less than 5 percent of all prostatic malignancies. Because atypical prostatic malignancies occur rarely, little is known about their biologic behavior. 7b date, no large series of patients have been reported, and specific treatment protocols have stet to be defined. Herein are describe 5 new eases of atypical prostatic cancer. By reporting the occurrence of newcases, we believe a better understanding of the natural history of these lesions will emerge.
Small cell carcinoma of the genitourinary tract: An immunohistochemical, electron microscopic and clinicopathological study
1991, Journal of Urology
We examined 13 cases of small cell carcinoma of the genitourinary tract to evaluate and compare the immunocytochemical and ultrastructural features as well as the clinicopathological behavior. Immunohistochemical stains revealed that neuron specific enolase and chromogranin showed differences in staining between the bladder and prostate, as well as between the small cell and adenocarcinomatous components of the prostate. Also, synaptophysin was negative over-all in 12 of 13 cases. Epithelial membrane antigen, carcinoembryonic antigen and keratin showed strong focal positivity within the small cell component. Electron microscopy was performed in 4 cases, with 3 demonstrating neurosecretory granules. Clinically, 6 of the 7 patients with adenocarcinoma/small cell carcinoma of the prostate did poorly, all with a survival of 15 months or less. Of 5 patients with transitional cell/small cell carcinoma of the bladder 2 fared better (both had no evidence of disease at 12 months and 11 years, respectively).
Based upon the immunostaining and electron microscopic findings, small cell carcinoma of the genitourinary tract is heterogeneous in appearance and, therefore, may arise from a multipotential cell of origin. This cell of origin may be organ-specific, as demonstrated by the variability in staining characteristics among the prostate, bladder and kidney, as well as by the differences in the clinical behavior of these malignancies. Small cell carcinoma of the prostate has a poor prognosis, while small cell carcinoma of the bladder may portend a better prognosis if diagnosed at an early stage.

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UropathologySmall-cell carcinoma of prostate

Abstract

Urology

Urology

Urology

Ectopic ACTH, prostatic oat cell carcinoma, and marked hypernatremia

Cancer

Relationship of ectopic ACTH production to tumor differentiation: a morphologic and immunohistochemical study of prostatic carcinoma with Cushing's syndrome

Cancer

The histogenesis of small cell carcinoma of the prostate. An immunchistochemical study

Cancer

Hyperadrenocorticism associated with “reactivated” prostatic carcinoma

Surgery

Extrapulmonary small cell carcinoma

Uropathology
Small-cell carcinoma of prostate