Small cell carcinoma of the prostate: rare but aggressive: different treatment needed

[JimJimJimJim]

Jim Marshall (not a doctor) said ...

A rare form of prostate cancer is called small cell carcinoma of the prostate. 

 

You should not be concerned about this unless your doctor mentions "small cell carcinoma" or "small cell cancer" or "neuroendocrine cancer". 

 

Then be sure that the doctor is talking about "small cell carcinoma of the prostate" and not another small cell carcinoma like small cell carcinoma of the kidney or small cell carcinoma of the lung. The information below applies only to the prostate variety.

 

Some men (less than 1%) have it as their initial diagnosis.

Sometimes it shows as a 'bonus' in aggressive cancers (Gleason score 9 or 10).

 

Treatment is usually early chemotherapy. For small cell carcinoma the chemo is different from the usual Taxotere (docetaxel) chemo.

 

One place to start further research is:

http://emedicine.medscape.com/article/1611899-overview

 

... end Jim

 

Alan Barlee (not a doctor) has prepared this summary of what he found out for a patient diagnosed with the condition:

 

•  Small-cell cancer (SCC) found in pure form in around 1% of PCa cases (although 25-50% show mixed phenotypes, especially in Gleason 9-10 patients and recurrent post-ADT patients)

• Shares many characteristics with small cell cancer of other organs (and therefore research into SCC of related cancers has useful relevance to prostate SCC. 

• Typically grows and metastasises early and rapidly, most often to bone, lung, liver and adrenals, and survival in most cases is lower than with the ‘usual’ PCa - often as low as 12-18 months

• SCC tumours often first manifest as a hard peripheral zone nodule (although metastasis to regional lymph nodes and beyond may already be progressing by then)

• Relevant diagnostic and monitoring imaging include bone scan, CT and MRI

• PSA and PAP (and androgen receptor) are often low with SCCs in relation to the extent of the disease, since the production of these antigen/enzyme entities is minimal from SCC cells 

• Relevant SCC-specific tests include NSE, chromogranin, synaptophysin and CD-56, supported by LDH, ALP and serum calcium

• Many SCCs do not respond to ADT or RT, and early chemotherapy is usually the prescribed treatment, since metastases are usually found when diagnosis is made 

• Cisplatin + etoposide (PE) (i.e. not docetaxel/Taxotere) - is the most widely administered therapy, with 4 (max 6) cycles  

• Related combinations used are carboplatin + etoposide, a platin + irinotecan (IP) or teniposide

• Recurrent SCC may usefully be treated with Gencitibine

• There are small differences only in overall survival between the above chemo alternatives, with selection mainly based on treatment-specific toxicities

• History and tracking of  of renal (kidney), liver (hepatic), blood, lung and heart functions - and imaging - are important during treatment, with modification of the treatment regime as indicated

• There is not a lot of research published on prostate SCC, but much of the work on other SCC (especially lung) is potentially applicable, and relevant off-label treatments often used

• Clinical trials should be scanned regularly for relevance, e.g. immunotherapy possibilities like sipuleucel-T (Provenge), ipilimumab (Yervoy), nivolumab spring to mind?

• Palliation options for both disease and treatment side effects are numerous, and include focused RT for bone pain, corticosteroids (e.g predisolone) for inflammation and a host of anti-emetics for nausea    

 

... end Alan