Diagnosing and Treating Small-Cell Carcinomas of Prostatic Origin

The predictive factors of prognosis and treatment strategies for small-cell carcinoma (SCC) of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC (GSCC) between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. A total of 18 patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow-up time was 15.5 months and progression-free survival (PFS) was 9.3 months. Primary tumor resection was attempted in 13 of 18 patients (72.2%) in whom radical surgery was performed in six of 14 (42.9%) limited disease patients. Most of the patients (13, 72.2%) received cisplatin-based chemotherapy. Patients who had normal lactic dehydrogenase (LDH) levels showed a significantly higher median PFS and overall survival (OS) compared with patients with high LDH levels (P = 0.030, P= 0.010). Patients with limited disease treated with a radical operation experienced a non-significant (P = 0.211) longer PFS compared with patients who were not treated, but this reached statistical significance after analyzing OS (P = 0.211, P= 0.039). Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin-based chemotherapy.

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“…GSCC mostly occurs in elderly men instead of women, which was found in the present study and in previous series 11121314…”

Section: Discussionsupporting

confidence: 88%

Genitourinary small-cell carcinoma: 11-year treatment experience

et al. 2014

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“…Regimens that include gemcitabine, docetaxel and carboplatin, or cisplatin have been attempted with variable success [40–42]. Radiotherapy is also used, since patients with a small carcinoma diagnosis are not common candidates for surgical treatment [10, 14, 43, 44]. However, primary surgery was the most important prognostic factor for prolonged survival in one study [45].…”

Section: Discussionmentioning

confidence: 99%

Review of Small Cell Carcinomas of the Prostate

et al. 2011

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Small cell carcinoma of the prostate is a rare neoplasm, with only a few series hitherto reported. A little less than half of the cases are associated with conventional acinar adenocarcinoma, which are usually high grade. Although consensus has not been reached, the majority of patients with small cell neuroendocrine carcinoma of the prostate have advanced disease at diagnosis and disproportionally low PSA levels compared to patients with conventional acinar adenocarcinoma. Treatment consists mainly of chemotherapy associated with surgery. Radiation therapy is reserved for selected cases. This study reviews the most up-to-date information on small cell carcinomas of the prostate.

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“…In addition, octreotide-scintigraphy (octreoscan), depicting mainly the expression of somatostatin receptor-2 (SSTR-2; Ref. 18) at a dosage of 185 MBq (5 mCi) using whole body scans 6 -8 h after injection, was performed at study entry in a subgroup of 22 patients. This enabled us to analyze (a) whether octreoscan findings were consistent with 99m Tc scintigraphy results for skeletal metastases, and (b) whether detection of SSTR-2 by octreoscan correlated with clinical responses to combination therapy, in a manner suggestive of a possible direct action of SM-A on metastatic cancer cells via SSTR-2.…”

Section: Methodsmentioning

confidence: 99%

Combination of Somatostatin Analog, Dexamethasone, and Standard Androgen Ablation Therapy in Stage D3 Prostate Cancer Patients with Bone Metastases

Koutsilieris

Mitsiades

Bogdanos

et al. 2004

Clinical Cancer Research

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Purpose: Androgen ablation-refractory prostate cancer patients (stage D3) develop painful bone metastases and limited responsiveness to conventional therapies, hence the lack of universally accepted "gold standard" treatment for this poor prognosis clinical setting. We tested the safety and efficacy in stage D3 patients of the combination hormonal therapy, which combines administration of somatostatin analog and dexamethasone with standard androgen ablation monotherapy (luteinizing-hormone releasing-hormone analog or orchiectomy).Experimental Design: Thirty eight patients with stage D3 prostate cancer (mean age 71.8 ؎ 5.9 years) continued receiving androgen ablation therapy in combination with oral dexamethasone (4 mg daily for the 1st month of treatment, tapered down to 1 mg daily by the 4th month, with 1 mg daily maintenance dose thereafter) and somatostatin analog (20 mg octreotide i.m. injections every 28 days).Results: Twenty-three of 38 patients (60.5%) receiving this combination regimen had partial responses [PR, >50% prostate-specific antigen (PSA) decline], 9 (21.1%) had stable disease, and 7 (18.4%) had progressive disease. In 47.7% (18 of 38) of patients, their serum PSA levels decreased with treatment but did not return to their respective baselines until the end of follow-up (or death from non-prostate cancer-related causes). The median time-to-return to baseline PSA was 12 months (95% CI, 7-17 months), median progression-free survival was 7 months (95% CI, 4.5-9.5 months), median overall survival was 14 months (95% CI, 10.7-17.4 months), and median prostate cancer-specific overall survival (defined as time from onset of combination therapy until prostate cancer-related death) was 16.0 months (95% CI, 11.9 -20.1 months). All patients reported significant and durable improvement of bone pain and performance status (for a median duration of 14 months; 95% CI, 9 -19 months), without major treatment-related side effects. We observed a statistically significant (P < 0.01) reduction in serum insulin-like growth factor-1 levels at response to the combination therapy. T levels remained suppressed within castration levels at baseline and throughout therapy, including relapse.Conclusion: The combination therapy of dexamethasone plus somatostatin analog and standard androgen ablation manipulation produces objective clinical responses and symptomatic improvement in androgen ablation-refractory refractory prostate cancer patients.

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Diagnosing and Treating Small-Cell Carcinomas of Prostatic Origin

Cited by 30 publications

References 41 publications

Genitourinary small-cell carcinoma: 11-year treatment experience

Genitourinary small-cell carcinoma: 11-year treatment experience

Review of Small Cell Carcinomas of the Prostate

Combination of Somatostatin Analog, Dexamethasone, and Standard Androgen Ablation Therapy in Stage D3 Prostate Cancer Patients with Bone Metastases

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