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prostate small cell carcinoma

Saturday 18 February 2012

prostatic small cell carcinoma

Clinical features

Many patients have a previous history of a hormonally treated acinar adenocarcinoma.

As the small cell carcinoma component predominates, serum PSA level falls and may be undetectable. While most small cell carcinomas of the prostate lack clinically evident hormone production, they account for the majority of prostatic tumours with clinically evident ACTH or antidiuretic hormone production.

Histopathology

Small cell carcinomas of the prostate histologically are identical to small cell carcinomas of the lung. In approximately 50% of the cases, the tumours are mixed small cell carcinoma and adenocarcinoma of the prostate.

Neurosecretory granules have been demonstrated within several prostatic small cell carcinomas.

Using immunohistochemical techniques small cell components are negative for PSA and PAP.

There are conflicting studies as to whether small cell carcinoma of the prostate is positive for thyroid transcription factor-1 (TTF-1), in order to distinguish them from a metastasis from the lung.

Prognosis

The average survival of patients with small cell carcinoma of the prostate is less than a year.

There is no difference in prognosis between patients with pure small cell carcinoma and those with mixed glandular and small cell carcinoma.

The appearance of a small cell component within the course of adenocarcinoma of the prostate usually indicates an aggressive terminal phase of the disease.

In a review of the literature of genitourinary small cell carcinoma, whereas cisplatin chemotherapy was beneficial for bladder tumours, only surgery was prognostic for prostate small cell carcinomas.

While this study concluded that hormonal manipulation and systemic chemotherapy had little effect on the natural history of disease in the prostate, the number of patients were small and others suggest to treat small cell carcinoma of the prostate with the same combination chemotherapy used to treat small cell carcinomas in other sites.