Neuroendocrine Prostate Cancer: Subtypes, Biology, and Clinical Outcomes

Neuroendocrine prostate cancer (NEPC) encompasses various clinical contexts, ranging from the de novo presentation of small cell prostatic carcinoma to a treatment-emergent transformed phenotype that arises from typical adenocarcinoma of the prostate. The development of resistance to potent androgen receptor signaling inhibition may be associated with the emergence of lethal, advanced castration-resistant prostate cancer with neuroendocrine differentiation. Clinically, small cell prostate cancer and prostate cancer with neuroendocrine differentiation are often manifested by the presence of visceral or large soft tissue metastatic disease, a disproportionately low serum prostate-specific antigen level relative to the overall burden of disease, and a limited response to targeting of the androgen signaling axis. These tumors are often characterized by loss of androgen receptor expression, loss of retinoblastoma tumor suppressor copy number or expression, amplification of Aurora kinase A and N-Myc, and activation of the PI3K pathway. However, a consensus phenotype-genotype definition of NEPC has yet to emerge, and molecularly based biomarkers are needed to expand on traditional morphologic and immunohistochemical markers of NEPC to fully define the spectrum of this aggressive, androgen receptor–independent disease. Emerging studies implicate a shared clonal origin with prostatic adenocarcinoma in many cases, with the adaptive emergence of unique cellular programming and gene expression profiles. Ongoing clinical studies are focused on developing novel targeted therapeutic approaches for this high-risk, lethal subset of disease, to improve on the limited durations of response often observed with traditional platinum-based chemotherapy.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe the diagnostic and histopathologic criteria of NEPC
  • Discuss the clinical features and outcomes of NEPC
  • Outline treatment options for patients with NEPC
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
05/09/2014
Course expires: 
05/09/2015
Cost:
$0.00

Rahul Aggarwal, MD
Department of Medicine, Division of Hematology/Oncology
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California

Tian Zhang, MD
Duke Cancer Institute, Department of Medicine
Duke University Medical Center
Durham, North Carolina

Eric J. Small, MD
Department of Medicine, Division of Hematology/Oncology
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California

Andrew J. Armstrong, MD, ScM
Duke Cancer Institute, Department of Medicine
Duke University Medical Center
Durham, North Carolina

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
05/09/2014
Course expires: 
05/09/2015

Price

Cost:
$0.00
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Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing