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Does small-cell phenotype predict the natural history of prostate cancer? A case study in disease behavior

Nature Clinical Practice Oncology volume 4, pages 551–554 (2007)Cite this article

Abstract

Background A 52-year-old man presented to his urologist with hematuria and symptoms of frequency and incomplete voiding. The patient received antibiotics without symptom resolution. His prostate-specific antigen (PSA) level was 6.6 ng/ml and digital rectal examination revealed a normal-sized firm prostate gland. Biopsy obtained by transurethral resection revealed poorly differentiated Gleason 9 adenocarcinoma of the prostate with small-cell/neuroendocrine features. Pure small-cell cancer or poorly differentiated prostate cancer may secrete little or no PSA. One should be alerted to this phenotype in a patient with large volume disease on biopsy or examination and a low PSA or PSA not in proportion to tumor burden.

Investigations Digital rectal examination, laboratory tests, cystoscopy, prostatic chips obtained from transurethral resection, prostate biopsy, bone scan, CT scan of the chest, abdomen and pelvis.

Diagnosis Poorly differentiated Gleason 9 adenocarcinoma of the prostate with small-cell/neuroendocrine features.

Management Transurethral resection, androgen blockade with a gonadotropin-releasing hormone analog and antiandrogen flutamide, oral bicalutamide, docetaxel and oral estramustine. Total pelvic exenteration with ileal conduit urinary diversion and permanent end-colostomy formation, percutaneous nephrostomy placement, cisplatin combined with etoposide.

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Figure 1: CT scan images of the patient's abdomen and pelvis

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Authors and Affiliations

  1. SF Slovin is a Genitourinary Medical Oncologist at the Sidney Kimmel Center for Prostate and Urologic Cancers at 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. Does small-cell phenotype predict the natural history of prostate cancer? A case study in disease behavior. Nat Rev Clin Oncol 4, 551–554 (2007). https://doi.org/10.1038/ncponc0910

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