Does small-cell phenotype predict the natural history of prostate cancer? A case study in disease behavior Journal Article
| Author: | Slovin, S. F. |
| Article Title: | Does small-cell phenotype predict the natural history of prostate cancer? A case study in disease behavior |
| 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 normalsized 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. |
| Keywords: | adult; human tissue; middle aged; antibiotic agent; clinical feature; histopathology; case report; cisplatin; treatment duration; antineoplastic agents; outcome assessment; follow up; lymph node metastasis; adenocarcinoma; prostate specific antigen; phenotype; computer assisted tomography; multiple cycle treatment; etoposide; antineoplastic combined chemotherapy protocols; antineoplastic agents, phytogenic; prediction; docetaxel; neuroendocrine tumor; gleason score; prostate-specific antigen; prostatic neoplasms; laboratory test; prostate biopsy; urinary diversion; androgen antagonists; taxoids; prostate adenocarcinoma; cystoscopy; bicalutamide; flutamide; gonadorelin derivative; antineoplastic agents, hormonal; transurethral resection; gonadotropin-releasing hormone; anilides; nitriles; tosyl compounds; digital rectal examination; small cell carcinoma; carcinoma, small cell; colostomy; disease activity; transurethral resection of prostate; nephrostomy, percutaneous; estramustine |
| Journal Title: | Nature Clinical Practice Oncology |
| Volume: | 4 |
| Issue: | 9 |
| ISSN: | 1743-4254 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2007-09-01 |
| Start Page: | 551 |
| End Page: | 554 |
| Language: | English |
| DOI: | 10.1038/ncponc0910 |
| PUBMED: | 17728713 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 3" - "Export Date: 17 November 2011" - "Source: Scopus" |
