Clinical and genomic characterisation of treatment-emergent small-cell neuroendocrine prostate cancer
Biopsying metastases in men progressing on modern hormone therapy found small-cell neuroendocrine prostate cancer in 17 percent, with a median survival under three years, showing how commonly the lineage switch occurs and why biopsy at progression matters.
Overview
Prospective multi-institutional study of 202 men with metastatic castration-resistant prostate cancer who underwent metastatic biopsy, with histological and transcriptomic classification of treatment-emergent small-cell neuroendocrine prostate cancer.
Small-cell neuroendocrine histology was found in 17 percent, associated with worse overall survival (36.6 versus 44.5 months), a distinct expression signature and low androgen receptor signalling; serum markers such as chromogranin were unreliable.
- Treatment-emergent small-cell neuroendocrine prostate cancer in 17 percent of biopsied patients.
- Median overall survival 36.6 vs 44.5 months for adenocarcinoma.
Biopsy of progressing lesions, especially with low PSA or visceral spread, is recommended to detect neuroendocrine transformation and switch to platinum-based therapy or trials.
- Selected patients undergoing biopsy at academic centres.