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focal neuroendocrine differentiation in prostatic adenocarcinoma

Saturday 18 February 2012

All prostate cancers show focal neuroendocrine differentiation, although the majority shows only rare or sparse single neuroendocrine cells as demonstrated by neuroendocrine markers.

In 5-10% of prostatic carcinomas there are zones with a large number of single or clustered neuroendocrine cells detected by chromogranin A immunostaining.

A subset of these neuroendocrine cells may also be serotonin positive.

Immunostaining for neuron-specific enolase, synaptophysin, bombesin/gastrin-releasing peptide and a variety of other neuroendocrine peptides may also occur in individual neoplastic neuroendocrine cells, or in a more diffuse pattern and receptors for serotonin and neuroendocrine peptides may also be present.

Vascular endothelial growth factor (VEGF) may also be expressed in foci of neuroendorine differentiation.

The definitional context of these other neuroendocrine elements (other than chromogranin A and serotonin) remains to be elucidated.

There are conflicting studies as to whether advanced androgen deprived and androgen independent carcinomas show increased neuroendocrine differentiation.

The prognostic significance of focal neuroendocrine differentiation in primary untreated prostatic carcinoma is controversial with some showing an independent negative effect on prognosis, while others have not shown a prognostic relationship.

In advanced prostate cancer, especially androgen independent cancer, focal neuroendocrine differentiation portends a poor prognosis and may be a therapeutic target.

Serum chromogranin A levels (and potentially other markers such as pro-gastin-releasing peptide) may be diagnostically and prognostically useful, particularly in PSA negative, androgen independent carcinomas.