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Neuroendocrine differentiation in prostate cancer: a sheep in wolf's clothing?

Nature Clinical Practice Urology volume 3, pages 138–144 (2006)Cite this article

Abstract

Neuroendocrine differentiation of the prostate is often associated with a dismal prognosis. Whilst it is relatively rare compared with other forms of prostate cancer, it nevertheless remains difficult to treat these cancers effectively and to maintain a durable response. Research aimed at understanding the complexity of neuroendocrine differentiation of the prostate has been conducted for some time. The cells involved in this process secrete a variety of factors that can influence growth patterns and regulatory pathways. Many of these factors can be monitored serologically, but the relationship between the biology of the tumor and clinical response is often discordant. This review outlines the difficulties in treating this disease, both at the time of diagnosis and in the metastatic setting, and focuses on an area of research that remains challenging to both the researcher and clinician.

Key Points

  • Prostate-cancer cell lines can be induced to differentiate into neuroendocrine cells when deprived of androgens or in the presence of interleukin-6 or increased levels of cyclic adenosine monophosphate

  • Clinical characteristics suggestive of a neuroendocrine tumor of the prostate include progressive symptoms, a low serum PSA level relative to the tumor burden, a poor response to hormonal ablation and visceral metastases

  • Immunohistochemistry or electron microscopy of tumor tissue can be used to identify neuroendocrine differentiation in prostate cancer

  • Although there is no definite marker, a number of different markers can be used in the diagnosis and management of patients with neuroendocrine prostate cancer (e.g. chromogranin A)

  • Neuroendocrine cancers are difficult to treat and are most effectively managed by certain combinations of chemotherapeutic drugs, which can be used in association with hormonal therapies and radiation of the prostate

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Authors and Affiliations

  1. Assistant Professor of Medicine in the Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Susan F Slovin

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  1. Susan F Slovin
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Correspondence to Susan F Slovin.

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The author declares no competing financial interests.

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Slovin, S. Neuroendocrine differentiation in prostate cancer: a sheep in wolf's clothing?. Nat Rev Urol 3, 138–144 (2006). https://doi.org/10.1038/ncpuro0435

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