title: Metastatic small cell carcinoma of the prostate: Population-based analysis of patient characteristics and treatment paradigms.
abstract: BACKGROUND
  Small cell carcinoma of the prostate is a rare malignancy comprising<1% of prostate cancers. Little is known about population-based treatment patterns for metastatic small cell carcinoma of the prostate. We evaluated clinical characteristics, treatment patterns, and survival outcomes.
  
  
  METHODS
  Using the National Cancer Database, we identified patients between 1998 and 2011 diagnosed with pure small cell carcinoma of the prostate as their only malignancy who presented with nodal involvement or distant metastasis.
  
  
  RESULTS
  Treatment information was available for 379 patients. Of them, 122 (32.5%) underwent chemotherapy (CT) alone, 25 (6.7%) received hormonal therapy (androgen-deprivation therapy) alone, 10 (2.7%) underwent radiation therapy alone, 3 (1%) underwent radical prostatectomy, and 167 (44.4%) underwent combination therapy. The 1- and 3-year survival rates were 35.3% and 4.4%, respectively. Those receiving any CT as part of their treatment had a median survival of 9.3 vs. 3.2 months for those not receiving it (P<0.001). Those receiving CT, androgen-deprivation therapy, and radiation had a median survival of 15.1 vs. 7 months for those receiving CT alone (P<0.001). On multivariable analysis (controlling for age, Charlson comorbidity index, extent of metastasis, prostate-specific antigen level, and type of treatment), older age (hazard ratio [HR] = 3.87; 95% CI: 1.41-9.34; P = 0.007) and distant metastatic disease (HR = 7.17; 95% CI: 1.62-31.8; P = 0.010) increased risk of death, whereas receipt of CT (HR = 0.15; 95% CI: 0.05-0.44; P = 0.001) decreased risk of death.
  
  
  CONCLUSIONS
  Men presenting with metastatic small cell carcinoma of the prostate have poor overall survival. Older patients and those presenting with distant metastases have an increased risk of death. It appears that patients receiving CT experience a modest survival benefit. The role of hormonal therapy in this population remains unclear.
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cohen
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patel
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Adam
authors.initials: A
authors.lastname: Weiner
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.affiliation: The University of Chicago Medicine, Chicago, IL. Electronic address: rszmulew@medicine.bsd.uchicago.edu.
authors.forename: Russell Z
authors.initials: RZ
authors.lastname: Szmulewitz
mesh_terms: D000368:Aged; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: Prostate cancer; Small cell carcinoma; Survival; Treatment