Abstract
Neuroendocrine carcinomas (NEC) of the prostate are rare, with only a few series hitherto reported. The objective of this study was to assess in a single institution the clinical and morphologic characteristics of neuroendocrine carcinomas diagnosed in needle core biopsies. The current study analyses seven cases diagnosed in needle biopsies at a large tertiary regional cancer center from Northeastern Brazil. Two pathologists reviewed specimens retrospectively, and demographic and morphologic characteristics were compared to 458 acinar tumors diagnosed in the same period. There were five small cell carcinomas and two low-grade neuroendocrine carcinomas (carcinoid). NEC were associated with an acinar component in 5/7 cases and the Gleason score of the acinar component was always > 6. The number of cores involved in prostates with NEC was greater (65% compared to 24% of acinar tumors, p < 0.05). The mean PSA at diagnosis was 417.7 (range 5.7-1593, SD 218.3), compared to 100.5 (p = 0.1) of acinar tumors (range 0.3-8545, SD 22.7). Prostates harboring NEC were bigger (p < 0.001, mean volume 240 mL vs. 53 mL of acinar tumors). Treatment of NEC included palliative surgery, chemotherapy, and hormonal therapy. NEC of the prostate is rare and often associated with a high-grade acinar component. Prostates with NEC tend to be larger and involve a greater number of cores than acinar tumors. PSA at diagnosis does not seem to predict the presence of NE tumors in needle biopsy.
Highlights
Neuroendocrine carcinomas (NEC) of the prostate are rare, representing less than 0.5% of prostate carcinomas in the few series reported to date [1,2,3,4,5,6,7,8]
The current classification of neuroendocrine carcinomas is based on the World Health Organization 2004 lung tumor classification, and it divides those tumors into well-differentiated neuroendocrine carcinomas, moderately-differentiated neuroendocrine carcinomas, and poorly-differentiated neuroendocrine carcinomas, which include two morphologic distinct entities [9]
There was no significant difference in tumor extent in biopsies between small cell carcinomas and carcinoid tumors
Summary
Neuroendocrine carcinomas (NEC) of the prostate are rare, representing less than 0.5% of prostate carcinomas in the few series reported to date [1,2,3,4,5,6,7,8]. The most common neuroendocrine carcinoma of the prostate is by far small cell carcinoma. It is estimated that up to 10% of prostate cancer in patients with androgen-resistant disease after long-term androgen deprivation therapy are high grade NEC, most with associated acinar adenocarcinoma [10]. Recognition of this entity via needle biopsies is critical, as its therapy differs significantly from that of usual acinar high-grade prostatic adenocarcinoma
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