Patterns of care and outcomes in small cell carcinoma of the prostate: A national cancer database analysis

Abstract

Background Small cell carcinoma (SCC) of the prostate is a rare, aggressive disease. Evidence is limited; however, the current standard of care is chemotherapy. The benefit of local treatment modalities is unknown. Methods We queried the National Cancer Database identifying all SCC/neuroendocrine cases of the prostate, excluding those with unknown nodal or metastatic status, unknown treatment, or those not receiving chemotherapy. Overall survival (OS) was calculated using Kaplan‐Meier curves. Multivariable Cox proportional hazards model was used to identify factors associated with survival. A further subgroup analysis was performed on the utility of local therapy on survival in the nonmetastatic setting. Results Our final cohort included 657 patients with a median age of 68. Most patients had positive lymph nodes (60.1%) and metastatic disease (70.0%). Median survival was 12 months (95% confidence interval [95% CI], 11.1‐13.3 months) with a median follow‐up of 11.8 months. Metastatic disease, age greater than or equal to 70, omission of androgen deprivation therapy (ADT), and lower income (P < .05 for all) were all associated with reduced OS. Patients with prostate‐specific antigen (PSA) greater than or equal to 33 ng/mL and those receiving ADT had better survival (P < .05). Those with nonmetastatic disease were more likely to undergo prostatectomy and/or prostatic/pelvic radiation (P < .0001). Prostatic/pelvic radiation in the nonmetastatic setting was associated with longer survival (P = .02). Though well powered, our study is limited by the selection bias inherent to all observational studies, despite the statistical methods utilized to reduce this effect. Conclusions Although chemotherapy is the mainstay of treatment, radiation to the prostate/pelvis may be beneficial in the nonmetastatic setting. In addition to chemotherapy, ADT may benefit patients with an elevated PSA.

Role of specialized composition of SWI/SNF complexes in prostate cancer lineage plasticity

“…Approximately 10–20% of CRPC cases treated with ARSi display a neuroendocrine phenotype 5 , 8 , 9 . CRPC-NE no longer responds to ARSi and carries a dismal prognosis, with a mean overall survival of 12 months and no specific standard of care treatment options available 10 . There is mounting evidence that CRPC-Adeno can transdifferentiate to an AR-indifferent state through a mechanism of lineage plasticity under specific genomic conditions, including but not limited to TP53, RB1 , and PTEN loss 4 , 11 – 13 .…”

Primitive small cell carcinoma of the prostate. Case report and revision of the literature

“…Rarely prostatectomy or radiotherapy alone have been shown to be curative because the tumor, in the majority of the cases, is metastatic (5), moreover, prostate SCC is usually not responsive to androgen deprivation and disease progression is not associated with rises in serum PSA values. In definitive, the best treatment remains the multidisciplinary approach by chemotherapy alone or combined with local therapy that could offer local palliation of clinical symptoms (5,10). In our case, the patient had a primitive prostate SCC characterized as locally advanced cancer involving bladder and kidney function in absence of documented distant metastases; therefore, we don't know if the patient died from prostate SCC or from concomitant onset systemic pathologies.…”

“…In addition, molecular studies have reported an increased expression of gene involved in cellular proliferation, cell cycle, neuroendocrine differentiation and mitosis. Metzger et al (5) reported on 657 men with neuroendocrine SCC an overall survival of 12 months. Wang et al (9) on 260 patients selected from Surveillance, Epidemiology, and End Results (SEER) database showed an increased incidence of prostate SCC over time that was characterized by presence of high stage (stage IV in 77.7%), nodes involvement (49%) and distant metastases (68%) with PSA values greater than 10 ng/ml only in 23% of the cases; although patients underwent chemotherapy (58.8%), surgery (25.4%) and, radiotherapy (31.9%) the observed survival rates of 1-year, 2-year, and 5-year were 42.1%, 22.1%, and 12.5%, respectively.…”

Prostate cancer hijacks the microenvironment

“…Seung Cho Lee and Robert A. Martienssen M icroRNAs (miRNAs) play important regulatory roles in the development of animals and plants, for instance by mediating gene expression and retrotransposon control 1,2 . They are generated through step-wise processing of primary miRNAs (pri-miRNAs) into precursor miRNAs (pre-miRNAs), but the synthesis mechanisms are complex and vary in different species.…”