Large Cell Prostate Cancer
Large cell prostate cancer is very rare. Because of this, we dont yet know how it develops, or the best ways to treat it.
It is aggressive and can spread quickly to other parts of the body. Most men who have large cell prostate cancer also have common prostate cancer at the same time. And its most common in men whove already had hormone therapy for normal prostate cancer.
Because neuroendocrine cells dont produce PSA, most men with large cell prostate cancer have a low PSA level. So a PSA test cant be used to diagnose or monitor your cancer. But if you have both large cell prostate cancer and common prostate cancer at the same time, you may have higher PSA levels. More research is needed before we can know whether PSA tests can help to diagnose large cell prostate cancer mixed with common cancer.
Most large cell prostate cancers are diagnosed when they have grown large enough press against the urethra , which can cause difficulty urinating . So large cell prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have large cell prostate cancer. You will also need scans to see if your cancer has spread.
Most men with large cell prostate cancer have chemotherapy . You may also be offered surgery and radiotherapy, depending on how much the cancer has grown and spread.
Staging Spread And Survival Rates
As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.
Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. It’s called the TNM system, for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
Using the TNM system, each man’s prostate cancer can be described in detail and compared to other men’s prostate cancer. Doctors use this information for studies and to decide on treatments.
As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As we’ve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:
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Clinical Information Of The Patients Reported In Literatures
The 26 cases were aged from 21 to 82 years . Because the median age was 61 years, patients were divided into two groups: < 59 years old and 60 years old. There were 15 cases in the 60 group . Most cases suffered from difficulty urinating, and 20 cases showed normal serum PSA levels. DRE indicated grade III prostate enlargement and hardening. Space-occupying lesions were detected by imaging examinations. Among them, 11 cases underwent prostate biopsies eight underwent transurethral resection of the prostate and seven underwent radical prostatectomy. For postoperative treatment, 13 cases received chemotherapy, two received radiotherapy, and 13 had a history of endocrine therapy .
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Lung Cancer Survival Rates
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Small Cell Prostate Carcinoma: A Case Report And Review Of The Literature
Abdullah Demirta
1Department of Urology, Erciyes University Medical Faculty, 38039 Kayseri, Turkey
2Department of Pathology, Erciyes University Medical Faculty, 38039 Kayseri, Turkey
3Department of Family Medicine, Erciyes University Medical Faculty, 38039 Kayseri, Turkey
Abstract
Small cell prostate cancer constitutes less than 1% of all prostate cancers and has a poor prognosis. A 60-year-old male patient presented with dysuria, pollakiuria, and nocturia of about 1-year duration.The total PSA level at admission was 47.50ng/mL. The prostate needle biopsy result was reported as adenocarcinoma Gleason 5 + 3. The patient underwent transurethral prostate resection and bilateral orchiectomy. The TUR-P pathology result was consistent with small cell neuroendocrine carcinoma. He was offered systemic chemotherapy but refused it. Examinations and tests at the third postoperative month showed diffuse liver metastasis and vertebral bone metastasis. He died at the 6 months after surgery.
1. Introduction
2. Case Report
3. Discussion
4. Conclusion
Disclosure
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Aggressive Prostate Cancer Subtype More Common Than Expected
t-SCNC is diagnosed by its appearance under the microscope. Compared with adenocarcinoma , t-SCNC cells are smaller and more crowded together.
The researchers also found genetic differences between t-SCNC and the adenocarcinoma subtype, which accounts for most prostate cancers at diagnosis. Taking advantage of these unique features may improve the diagnosis and treatment of t-SCNC, said lead investigator Rahul Aggarwal, M.D., of the University of California, San Francisco.
The study was published July 9 in the Journal of Clinical Oncology.
The fact that nearly 20% had this subtype is a surprise, said William Dahut, M.D., head of the Prostate Cancer Clinical Research Section of NCIs Center for Cancer Research. Thats a greater percentage than we thought.
This finding could lead to clinical trials specifically for men with this subtype of prostate cancer, Dr. Dahut added.
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Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
Emergence Of The Neuroendocrine Subtype
Potent hormone therapies like abiraterone and enzalutamide can be effective treatments for men with castrate-resistant prostate cancer. However, almost all men eventually develop drug resistance to these agents.
In some cases, the drug-resistant cancer may look and behave differently than the original cancer, so much so that it is considered a different subtype of the disease. For example, some men who were originally diagnosed with adenocarcinoma prostate cancer develop t-SCNC after treatment with abiraterone or enzalutamide.
Under the microscope, t-SCNC looks quite different from adenocarcinoma: the cells are smaller and more crowded together. And compared to adenocarcinoma prostate tumors, tumors of the t-SCNC subtype are thought to have less hormone signaling and lower prostate-specific antigen.
In addition, t-SCNC shares some features with a small-cell neuroendocrine subtype of prostate cancer that appears in less than 1% of men with newly diagnosed prostate cancer.
To understand how frequently t-SCNC develops after hormone treatment, Dr. Aggarwal and his colleagues analyzed metastatic tumor samples from 202 men with castrate-resistant prostate cancer who had received treatment at multiple institutions. The samples were obtained from metastatic tumors in the bone, lymph nodes, liver, or other soft tissues.
The anatomical site where the metastatic tumor sample had been taken did not appear to affect the frequency of the neuroendocrine subtype, the researchers found.
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Clinical And Pathological Information Of The Cases From Plagh
In total, 1,002 cases of prostate cancer were diagnosed pathologically at the Chinese PLA General Hospital from 1999 to 2011, and seven of them were suspected of SmCC. All pathologic sections from these seven cases were reviewed by three pathologists. Immunohistochemical staining for prostate-specific antigen , CD56, synaptophysin , chromogranin A , and cytokeratin was performed. Four cases were excluded because of the negative staining for CD56, Syn, and CgA, which were suspected to be poorly differentiated acinar adenocarcinomas with Gleason scores 9-10. The remaining three cases were confirmed as SmCC. Detailed clinical and pathological information is presented below.
Case 1. Mixed SmCC. Components of SmCC. Components of acinar adenocarcinoma. Gleason scores were 3+3=6 combined with bilateral lung and liver metastases.
Case 2. A 65-year-old patient was referred to our hospital with symptoms of dysuria and frequent urination. The serum PSA level was 20.67ng/mL . DRE indicated the prostate was homogeneously enlarged and the central sulcus disappeared. MRI showed a mass in the prostate, combined with pelvic lymph node metastasis. He underwent an ultrasound-guided prostate biopsy. Combined SmCC and acinar adenocarcinoma were confirmed pathologically. The patient received endocrine therapy. The 4-month follow-up showed tumor-bearing survival, and the general condition of the patient was poor.
Patient And Disease Variables
In our study cohort, the median age at diagnosis was 70 6276) . Survival data were available for 197 patients with a median follow-up time of 14 months and a total of 158 deaths. A majority of patients were white , lived in a metropolitan area and received treatment at a comprehensive cancer program . The year of diagnosis and region of diagnosis were evenly distributed across the study period. For patients with known CCI, the majority had CCI of 0 . Of the patients diagnosed after 2003, the median PSA was 4.9ngml1 and 61% presented with elevated measurements . Among men with recorded clinical T stage, 73% were staged cT12.
Table 1 Patient, hospital and clinical characteristics
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How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
Working To Treat A Deadly Form Of Prostate Cancer
July 11, 2018
A deadly form of advanced prostate cancer is more common than experts previously thought.
A new study looked at about 200 men with prostate cancer that had spread and were resistant to standard treatment. It found that about 17 percent of the men had developed a deadlier subtype of prostate cancer called treatment-emergent small cell neuroendocrine prostate cancer.
Clinical recognition of the emergence of small cell carcinoma during the usual progression of prostate cancer is increasing, said Moffitt pathologist Dr. Jasreman Dhillon. The increase is largely attributed to the use of more effective androgen deprivation therapies in recent years. This type of prostate cancer progresses rapidly and combinational chemotherapy is the only treatment option at this time.
The studys findings suggest the deadly cancer subtype could also be successfully treated with targeted therapy, a type of treatment that is tailored to individual tumors.
Moffitt is already using a type of individualized treatment called adaptive therapy. It utilizes mathematical models to analyze a patients response to treatment to create a unique and constantly evolving treatment strategy.
Dr. Jingsong Zhang, a medical oncologist in Moffitts Genitourinary Oncology Program, is currently conducting a clinical trial of adaptive therapy for prostate cancer patients.
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Prognosis And Survival For Prostate Cancer
If you have prostate cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for prostate cancer.
Apalutamide Plus Cetrelimab In Patients With Treatment
| The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. |
| First Posted : June 15, 2021Last Update Posted : March 23, 2022 |
- Study Details
| Small Cell Neuroendocrine CarcinomaProstate CancerSmall Cell Carcinoma | Drug: ApalutamideBiological: Cetrelimab | Phase 2 |
This is a phase 2, single arm, Simon’s two-stage evaluation of the combination of apalutamide plus cetrelimab in patients with mCRPC and histologic and/or genomic evidence of treatment-emergent small cell neuroendocrine prostate cancer who have previously progressed on at least one prior androgen signaling inhibitor.
Participants may continue study treatment from the time of treatment initiation until confirmed radiographic progressive disease per PCWG3 and RECIST 1.1 criteria, unequivocal clinical progression, unacceptable toxicity, or patient withdrawal, whichever occurs first, for a maximum of 24 months.
PRIMARY OBJECTIVE:
I. To determine the composite response rate as defined by achieving one or more of the following at any time point during study treatment:
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Prostate Cancer With A Normal Psa: Small Cell Carcinoma Of The Prostate A Rare Entity
Pure small cell carcinoma of the prostate is extremely rare. When it does occur, it is usually in concordance with prostatic adenocarcinoma. Early diagnosis is difficult as the carcinoma tends to spread early to visceral organs without concordant elevation of prostate-specific antigen . Because this condition is rare, no standard treatment regimen has been established, and the overall prognosis remains poor.
This case report describes clinical characteristics of a 67-year-old man with pure small cell carcinoma of the prostate. The unique clinical and biological features of this histologic type of prostate cancer are discussed.
Basal Cell Prostate Cancer
You might also hear this called adenoid cystic prostate cancer or basaloid carcinoma. Men who have basal cell prostate cancer can also have common prostate cancer at the same time. We dont know how aggressive it is. Some studies suggest it isnt very aggressive. But other studies suggest it might be more aggressive than common prostate cancer.
Basal cells dont produce PSA, and most men with basal cell prostate cancer have normal levels of PSA in their blood. This means that a PSA test probably wont help to diagnose basal cell prostate cancer.
Basal cell cancer can grow big enough to cause the urethra to narrow, this can cause difficulty urinating. So basal cell prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have basal cell prostate cancer. You will also have scans to see if your cancer has spread.
Your treatment options will depend on how much the cancer has grown and whether it has spread to other parts of the body. You may be offered:
- or a combination of these treatments.
Your doctor or nurse will tell you what treatment options are available to you.
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Retrieval Method Of The Related Literature
All literature reports relating to SmCC of the prostate were accessed from the China Hospital Knowledge Database , the Chinese Medical Journal Database , the Chinese Medical Citation Index , and the Wanfang Database using the keywords small cell carcinoma, prostate, and neuroendocrine. The search located 29 cases in 19 reports -. The contents of these reports were then reviewed. Two cases were found to be duplicated and were eliminated -. Another case was also eliminated due to incomplete clinical and pathological data . In total, 26 cases were eligible -. Data on age, clinical symptoms and signs, serum PSA levels, DRE findings, ultrasound scans and MRI, surgical approach, postoperative therapy, follow-up time, and survival were collected.