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Small cell carcinoma of the prostate

Nature Reviews Urology volume 11, pages 213–219 (2014)Cite this article

Subjects

Key Points

  • Small-cell carcinoma (SCC) of the prostate is a rare subtype of prostate cancer characterized by an aggressive clinical course

  • Approximately 40–50% of men with prostatic SCCs have a history of conventional prostatic adenocarcinoma

  • SCC of the prostate is usually not responsive to androgen deprivation and disease progression is not associated with rises in serum PSA levels

  • A biopsy of accessible lesions should be considered when SCC is suspected

  • Chemotherapy represents the backbone of management for men with advanced prostatic SCC

  • SCC is radiosensitive and radiotherapy might offer local palliation of symptoms such as bladder outlet obstruction and pain

Abstract

Pure small-cell carcinoma (SCC) of the prostate is a rare entity and one of the most aggressive malignancies of the prostate. Histologically, prostatic SCCs of the prostate are part of a spectrum of anaplastic tumours of the prostate and are similar to SCCs of the lungs. In most cases, SCC of the prostate is associated with conventional prostatic adenocarcinoma. Both components of these mixed tumours frequently share molecular alterations such as ERG gene rearrangements or AURKA and MYCN amplifications, suggesting a common clonal origin. The clinical behaviour of small-cell prostate carcinomas is characterized by extensive local disease, visceral disease, and low PSA levels despite large metastatic burden. Commonly, the emergence of the SCC occurs in patients with high-grade adenocarcinoma who are often treated with androgen deprivation treatment (ADT). However, SCCs do not usually benefit from ADT. A biopsy of accessible lesions is strongly recommended to identify those with SCC pathological features, as management is undoubtedly affected by this finding. Chemotherapy is the standard approach for treating patients with either localized or advanced prostatic SCC. Despite the emergence of more-aggressive treatment modalities, the prognosis of men with prostatic SCC remains dismal.

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Figure 1: Morphologic spectrum of prostatic neuroendocrine tumours.

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Article 04 February 2021

Richard J. Rebello, Christoph Oing, … Robert G. Bristow

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Authors and Affiliations

  1. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans Street, Baltimore, 21231-1000, MD, USA

    Rosa Nadal, Michael Schweizer & Mario A. Eisenberger

  2. Department of Pathology, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4100, Miami, 33136, FL, USA

    Oleksandr N. Kryvenko

  3. Department of Pathology, Johns Hopkins Hospital, The Weinberg Building, Room 2242, 401 North Broadway Street, Baltimore, 21231, MA, USA

    Jonathan I. Epstein

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R.N., M.S., and O.N.K. researched data and were involved in writing the article. J.I.E. and M.A.E. contributed to discussions of content and reviewed and edited the manuscript before submission.

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Correspondence to Mario A. Eisenberger.

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Nadal, R., Schweizer, M., Kryvenko, O. et al. Small cell carcinoma of the prostate. Nat Rev Urol 11, 213–219 (2014). https://doi.org/10.1038/nrurol.2014.21

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