# Clinical and genomic characterisation of treatment-emergent small-cell neuroendocrine prostate cancer

Source: https://onco.cc/key-papers/paper-aggarwal-t-sccpc-jco-2018/  
OnCo record `paper-aggarwal-t-sccpc-jco-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Biopsying metastases in men progressing on modern hormone therapy found small-cell neuroendocrine prostate cancer in 17 percent, with a median survival under three years, showing how commonly the lineage switch occurs and why biopsy at progression matters.

## Summary

Prospective multi-institutional study of 202 men with metastatic castration-resistant prostate cancer who underwent metastatic biopsy, with histological and transcriptomic classification of treatment-emergent small-cell neuroendocrine prostate cancer.

Small-cell neuroendocrine histology was found in 17 percent, associated with worse overall survival (36.6 versus 44.5 months), a distinct expression signature and low androgen receptor signalling; serum markers such as chromogranin were unreliable.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Journal of Clinical Oncology
- Year: 2018
- DOI: 10.1200/JCO.2017.77.6880
- Authors: Aggarwal R, Huang J, Alumkal JJ, et al.
- Findings: Treatment-emergent small-cell neuroendocrine prostate cancer in 17 percent of biopsied patients.; Median overall survival 36.6 vs 44.5 months for adenocarcinoma.
- What it means: Biopsy of progressing lesions, especially with low PSA or visceral spread, is recommended to detect neuroendocrine transformation and switch to platinum-based therapy or trials.
- Caveats: Selected patients undergoing biopsy at academic centres.

## Sources

- J Clin Oncol 2018: https://doi.org/10.1200/JCO.2017.77.6880
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29985747/

## Connected records

- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- key papers: [SOX2 promotes lineage plasticity and antiandrogen resistance in TP53- and RB1-deficient prostate cancer](https://onco.cc/key-papers/paper-mu-sox2-lineage-plasticity-science-2017/)
- ideas: [Watch for the cancer changing cell type before the biopsy says neuroendocrine, and act on it](https://onco.cc/ideas/idea-prostate-plasticity-surveillance-before-it-is-neuroendocrine/)
- cancers: [Neuroendocrine and small-cell prostate cancer](https://onco.cc/cancers/prostate-nepc/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- terms: [Neuroendocrine differentiation in prostate cancer](https://onco.cc/terms/neuroendocrine-differentiation/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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