Neuroendocrine Prostate Cancer
Neuroendocrine prostate cancer (NEPC) is a highly aggressive subtype of prostate cancer that may either arise de novo or much more commonly after hormonal therapy for prostate adenocarcinoma. It is estimated that up to 30 % of late stage prostate cancers
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Himisha Beltran, Juan Miguel Mosquera, and Mark A. Rubin
Neuroendocrine prostate cancer (NEPC) is a highly aggressive subtype of prostate cancer that may either arise de novo or much more commonly after hormonal therapy for prostate adenocarcinoma. It is estimated that up to 30 % of late stage prostate cancers harbor a predominance of neuroendocrine differentiation [1]. However, due to a general lack of biopsy diagnoses for advanced disease, this may underrepresent the frequency of neuroendocrine PCa (NEPC). Since androgen deprivation therapy promotes the development of NEPC, its incidence is anticipated to escalate with the introduction of new potent hormonal agents into the clinical arena. NEPC is more aggressive than prostate adenocarcinoma, does not secrete prostate specific antigen (PSA) or express androgen receptor [2], and can be suspected in patients with progressive disease despite a normal or modestly elevated PSA and/or elevated serum markers of neuroendocrine differentiation (i.e., chromogranin A or neuron-specific enolase (NSE)). These tumors are highly aggressive, with nearly all patients dying within 1 year of diagnosis [25].
H. Beltran, M.D. (*) Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, Box 403, New York, NY 10065, USA e-mail: [email protected] J.M. Mosquera, M.D., M.Sc. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, ST-1015B, New York, NY 10065, USA e-mail: [email protected] M.A. Rubin, M.D. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 1300 York Avenue, C-410, New York, NY 10065, USA e-mail: [email protected] A. Tewari (ed.), Prostate Cancer: A Comprehensive Perspective, DOI 10.1007/978-1-4471-2864-9_22, © Springer-Verlag London 2013
Neuroendocrine Cells in the Normal Prostate The epithelial compartment of the normal prostate gland is composed of basal cells, secretory (luminal) epithelial cells, and neuroendocrine (NE) cells. Prostate adenocarcinoma shows features of secretory cells. Basal cells are androgen insensitive and have recently been shown to display stem cell features [27]. Neuroendocrine cells are distributed throughout the normal prostate (
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