Appointment sheet
Neuroendocrine and small-cell prostate cancer
Prepared with OnCo (onco.cc/prep/prostate-nepc/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
17 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Synaptophysin, chromogranin and INSM1 staining, Loss of androgen receptor and PSA expression, Combined RB1 and TP53 loss, MYCN and AURKA amplification, DLL3 expression), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Small-cell or predominantly neuroendocrine
- 5.For my situation (small-cell or predominantly neuroendocrine), which of the standard options do you recommend and why?
- 6.Am I a candidate for Platinum + etoposide (EP / CE), Cisplatin, Carboplatin or related drugs, and what side effects should I expect?
Mixed adenocarcinoma and neuroendocrine, or aggressive variant
- 7.For my situation (mixed adenocarcinoma and neuroendocrine, or aggressive variant), which of the standard options do you recommend and why?
- 8.Am I a candidate for Carboplatin, Docetaxel, Cabazitaxel, and what side effects should I expect?
Recognition and biopsy
- 9.For my situation (recognition and biopsy), which of the standard options do you recommend and why?
- 10.Am I a candidate for Pembrolizumab, and what side effects should I expect?
Trials
- 11.For my situation (trials), which of the standard options do you recommend and why?
- 12.Am I a candidate for Tarlatamab, Mevrometostat, Lurbinectedin, and what side effects should I expect?
Any stage
- 13.Are there clinical trials I could join, for example of Tarlatamab, Mevrometostat, Lurbinectedin, Ifinatamab deruxtecan?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “No approved therapy specific to the disease; every regimen is borrowed from lung cancer”. How does that affect my plan?
- 17.I read that “No blood test reliably detects the lineage switch before it shows on scans”. How does that affect my plan?
The words I may hear
- Neuroendocrine differentiation in prostate cancer: Prostate cancer cells that have taken on the look and the markers of nerve-and-hormone cells.
- Acinar adenocarcinoma of the prostate: The ordinary type of prostate cancer, more than 95 in every 100 cases.
- Castration-resistant prostate cancer (CRPC): Prostate cancer that keeps growing even though testosterone has been reduced to castrate levels.
- Radiographic progression-free survival (rPFS): In cancer that has already spread, this is the time until the scans show it getting worse, or the man dies.
- TNM staging for prostate cancer, and what changed in the 9th edition: The anatomical stage of prostate cancer: how far the tumour has grown (T), whether it is in the pelvic lymph nodes (N) and whether it has spread further (M).
- Histologic transformation: When a lung adenocarcinoma escapes targeted therapy by turning into a different cell type, usually small-cell.
Tests and results to bring
Biomarker results to ask for: Synaptophysin, chromogranin and INSM1 staining, Loss of androgen receptor and PSA expression, Combined RB1 and TP53 loss, MYCN and AURKA amplification, DLL3 expression, Serum chromogranin A, neuron-specific enolase and lactate dehydrogenase, FDG PET-avid, PSMA PET-negative lesions.
Scans and tests linked to this cancer: PET (positron emission tomography), PSMA PET.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Small-cell or predominantly neuroendocrine: Cisplatin or carboplatin with etoposide, as for small-cell lung cancer; continue androgen deprivation; brain imaging. (Platinum + etoposide (EP / CE), Cisplatin, Carboplatin, Etoposide, Androgen deprivation & AR pathway inhibitors)
- Mixed adenocarcinoma and neuroendocrine, or aggressive variant: Carboplatin plus docetaxel or cabazitaxel, then platinum with etoposide; clinical trial enrolment preferred. (Carboplatin, Docetaxel, Cabazitaxel, Cytotoxic chemotherapy)
- Recognition and biopsy: Biopsy any progression with low PSA, visceral metastases or PSMA-negative FDG-avid lesions; test for mismatch repair deficiency (pembrolizumab) and HRR genes. (PSMA PET, PET (positron emission tomography), Pembrolizumab)
- Trials: DLL3 T-cell engagers (tarlatamab), EZH2 inhibitors and aurora kinase inhibitors against the lineage switch; lurbinectedin borrowed from small-cell lung cancer. (Tarlatamab, DLL3, Mevrometostat, EZH2, Lurbinectedin)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call