DataNeuroendocrine and small-cell prostate cancer

Direct links plus the targets, companies, and technologies of this cancer's products.

• This page is a tumour type, not a disease state. The WHO fifth edition gives treatment-related neuroendocrine prostatic carcinoma its own section inside the prostate chapter, rather than folding it into the classification's consolidated neuroendocrine chapter, because of its distinctive clinical and biological behaviour. It is defined there as tumours demonstrating complete neuroendocrine differentiation, or partial neuroendocrine differentiation with adenocarcinoma, following androgen deprivation therapy, and the definition covers both the primary and its metastases (Kench 2022).
• What a UK report will and will not do with it. Neuroendocrine carcinomas are not Gleason graded. The dataset in force does not ask for routine synaptophysin and chromogranin staining of ordinary prostate adenocarcinoma, because almost all of them show some neuroendocrine differentiation and there is not enough evidence that finding it changes treatment or prognosis; the stains are for tumours that already look neuroendocrine down the microscope. PSA and NKX3.1 are usually lost in these tumours, which is one of the reasons the PSA can stay low while the disease advances (RCPath G084).
• How common it is in the setting where it matters. Treatment-related neuroendocrine prostatic carcinoma is found in 10.5 to 17 percent of people with metastatic castration-resistant prostate cancer after treatment with androgen receptor signalling inhibitors (Kench 2022). The evidence is that these carcinomas arise by transformation of an existing adenocarcinoma rather than from neuroendocrine cells, which is what lineage plasticity means here and why it is a route to resistance rather than a second cancer.

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