Does small-cell phenotype predict the natural history of prostate cancer? A case study in disease behavior.
BACKGROUND
A 52-year-old man presented to his urologist with hematuria and symptoms of frequency and incomplete voiding. The patient received antibiotics without symptom resolution. His prostate-specific antigen (PSA) level was 6.6 ng/ml and digital rectal examination revealed a normal-sized firm prostate gland. Biopsy obtained by transurethral resection revealed poorly differentiated Gleason 9 adenocarcinoma of the prostate with small-cell/neuroendocrine features. Pure small-cell cancer or poorly differentiated prostate cancer may secrete little or no PSA. One should be alerted to this phenotype in a patient with large volume disease on biopsy or examination and a low PSA or PSA not in proportion to tumor burden.


METHODS
Digital rectal examination, laboratory tests, cystoscopy, prostatic chips obtained from transurethral resection, prostate biopsy, bone scan, CT scan of the chest, abdomen and pelvis.


METHODS
Poorly differentiated Gleason 9 adenocarcinoma of the prostate with small-cell/neuroendocrine features.


RESULTS
Transurethral resection, androgen blockade with a gonadotropin-releasing hormone analog and antiandrogen flutamide, oral bicalutamide, docetaxel and oral estramustine. Total pelvic exenteration with ileal conduit urinary diversion and permanent end-colostomy formation, percutaneous nephrostomy placement, cisplatin combined with etoposide.
Slovin
Susan F
SF
Genitourinary Oncology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. slovins@mskcc.org
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D000726:Androgen Antagonists / Q000008:administration & dosage; D000813:Anilides / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols; D018288:Carcinoma, Small Cell / Q000473:pathology*; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D004961:Estramustine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005485:Flutamide / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D009570:Nitriles / Q000008:administration & dosage; D010641:Phenotype; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D043823:Taxoids / Q000008:administration & dosage; D014105:Tosyl Compounds / Q000008:administration & dosage; D020728:Transurethral Resection of Prostate; D014547:Urinary Diversion
D000726:Androgen Antagonists; D000813:Anilides; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D000972:Antineoplastic Agents, Phytogenic; D009570:Nitriles; D043823:Taxoids; D014105:Tosyl Compounds; D000077143:Docetaxel; D007987:Gonadotropin-Releasing Hormone; D004961:Estramustine; D005047:Etoposide; D005485:Flutamide; C053541:bicalutamide; D017430:Prostate-Specific Antigen; D002945:Cisplatin