title: Population-based analysis of treatment modalities and survival for clinically localized small-cell carcinoma of the prostate.
abstract: BACKGROUND
  Small-cell carcinoma of the prostate is an aggressive cancer whose rarity has prevented the development of a consensus management approach. The objective of the current study was to determine the treatment patterns and evaluate factors affecting overall survival for patients with localized small-cell carcinoma of the prostate.
  
  
  METHODS
  After querying the National Cancer Database, we identified all patients diagnosed with localized small-cell carcinoma of the prostate between 1998 and 2011 (n=287). Using Kaplan-Meier curves and Cox regression analyses, we assessed the effect of treatment and clinical stage on overall survival.
  
  
  RESULTS
  Treatments included radiation therapy in 46% (n=131), chemotherapy in 38% (n=107), androgen deprivation therapy (ADT) in 22% (n=63) and radical prostatectomy in 13% (n=38). Median overall survival was 14.8 months. Upon multivariate analysis, local therapy (radical prostatectomy or radiation therapy) was associated with improved survival (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.14-0.38, P<0.001). Advanced clinical stage predicted worse survival among all men (cT3: HR 2.83, 95% CI 1.27-6.32, P=0.011; cT4: HR 3.26, 95% CI 1.50-7.07, P=0.003) and men who received local therapy (cT3: HR 4.67, 95% CI 1.41-15.44, P=0.012; cT4: HR 4.01, 95% CI 1.14-14.08, P=0.03) but not among men who received no local therapy (cT3: HR 1.64, 95% CI 0.51-5.27, P=0.4; cT4: HR 2.35, 95% CI 0.74-7.48, P=0.15). Age, receipt of chemotherapy and ADT, and clinical stage T2 disease (compared with T1) did not predict survival.
  
  
  CONCLUSIONS
  Men with localized small-cell carcinoma of the prostate have a poor overall survival. Local therapy may represent a suitable and underused modality for select patients.
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Weiner
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Richards
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: R Z
authors.initials: RZ
authors.lastname: Szmulewitz
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003131:Combined Modality Therapy; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009367:Neoplasm Staging; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology / Q000208:ethnology