Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Volume 24, Issue 4, Pages 313-317 (July 2006)

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Masahiro Yashi, M.D., Fumihito Terauchi, M.D., Akinori Nukui, M.D.,Masanori Ochi, M.D., Masayuki Yuzawa, M.D., Yosuke Hara, M.D., Tatsuo Morita, M.D.

Received 3 June 2005; received in revised form 29 August 2005; accepted 30 August 2005.

Abstract

Background

Small-cell neuroendocrine carcinoma has been recognized as a rare histologic variant occurring in only 0.5% to 2% of prostatic primary tumors. However, recent autopsy studies suggest development to this phenotype in up to 10% to 20% of the cases with hormone-refractory disease.

Case Presentation

A case of conventional adenocarcinoma before androgen-ablation therapy but showing progression to small-cell neuroendocrine carcinoma at the recurrence. The immunohistochemistry of the tumor showed strong positive staining for progastrin-releasing peptide (ProGRP), a carboxy terminal region common to 3 precursors for gastrin-releasing peptide, but almost negative staining for chromogranin-A and prostate-specific antigen. Combination chemotherapy based on cisplatin and etoposide was effective for controlling the tumor progression for 7 months, and the serum ProGRP level correlated well to the clinical course. Neither objective nor subjective responses were observed to somatostatin analogue therapy performed in the late stage of disease.

Conclusions

The present case reminds the urologist that small-cell neuroendocrine carcinoma may be a variant form of disease recurrence during androgen ablation in advanced prostate cancer. A strategic approach for this phenotype evaluating serum neuroendocrine markers, such as ProGRP, should be taken when serum prostate-specific antigen does not reflect the disease state. This approach would allow one to choose alternative therapies targeting neuroendocrine cells other than androgen ablation.

Keywords: Prostate cancer , Small-cell carcinoma , Neuroendocrine marker ,Progastrin-releasing peptide


My channel TURP biopsy sample indicate this neuro endocrine feature & Onchosurgeon Dr.Kathiresan may decide alternative therapy after reviewing on 15th.March 2011 with PSA test.