Very rarely, prostate cancer starts in neuroendocrine cells. Some prostate cancers become resistant to treatment and turn into neuroendocrine tumors, which are more aggressive and have a poorer outlook.
Prostate cancer is the
Neuroendocrine prostate cancer (NEPC) is rare and tends to be highly aggressive. Neuroendocrine tumors develop in cells that produce hormones in response to electrical signals from your nervous system.
NEPC can be a pure neuroendocrine tumor or share features with adenocarcinoma. The
- adenocarcinoma with neuroendocrine differentiation
- well-differentiated neuroendocrine tumors
- small-cell neuroendocrine carcinoma
- large cell neuroendocrine carcinoma
Keep reading to learn more about how NEPC differs from adenocarcinoma.
NEPC develops in neuroendocrine cells that can secrete many different substances in response to neural signals, such as:
- chromogranin A
NEPC can develop as a new cancer or transform from adenocarcinoma that doesn’t respond to hormone therapy. Doctors call it “de novo” NEPC when it develops as a new cancer.
Researchers aren’t entirely sure why some people develop neuroendocrine tumors. But, like all cancers, they develop when mutated genes cause cells to replicate uncontrollably.
Adenocarcinoma transformation to neuroendocrine tumors
Almost everyone with prostate cancer has adenocarcinoma. This cancer develops in glands that produce prostate fluid.
- if your cancer has spread too far for treatment with surgery or radiation therapy
- if your cancer comes back after surgery or radiation therapy
- together with radiation therapy if you have a high risk of your cancer relapsing
- before radiation therapy to shrink cancer cells
Cancers that continue to grow even when androgen levels are reduced are called castrate-resistant prostate cancers. As many as 17–40% of people with castrate-resistant prostate cancer develop neuroendocrine tumors.
Transformation to NEPC becomes more likely the longer hormone therapy continues.
How common is neuroendocrine prostate cancer?
De novo NEPC is very rare. Experts think it makes up 0.5–1% of newly diagnosed prostate cancers.
Most cases of NEPC are due to the transformation of castrate-resistant adenocarcinoma.
Many of the early symptoms of NEPC are related to changes in how you urinate.
According to Neuroendocrine Cancer UK, symptoms of NEPC can include:
- frequent urination
- weak urine flow
- frequent urination at night
- new erectile dysfunction
- blood in urine
- pain when sitting
- blood in semen
- pain during urination
Later signs and symptoms may include:
NEPC that develops after hormone therapy has several characteristic
- low prostate-specific antigen (PSA) levels
- high chance of spreading to distant body parts
- rapid resistance to hormone therapy medications
A biopsy is the main tool for diagnosing all types of prostate cancer, including NEPC. It’s when a doctor takes a small tissue sample so a specialist called a pathologist can examine the cells under a microscope.
Other tests that doctors use to support a prostate cancer diagnosis include:
Treating NEPC often involves the removal of the prostate gland, followed by platinum-based chemotherapy regimens used to treat small cell lung cancer (SCLC). Treatment with cisplatin and carboplatin with either docetaxel or etoposide seems to have a
Researchers continue to examine treatments that may help treat NEPC in the future. Treatments under investigation include:
- poly ADP ribose polymerase (PARP) inhibitors
- checkpoint inhibitors
- tyrosine kinase inhibitors
- platinum therapies
Neuroendocrine tumors are responsible for about a
Adenocarcinoma tends to have a much better outlook. People with adenocarcinoma limited to the prostate or surrounding area are
NEPC is a rare type of prostate cancer that tends to be aggressive and has a poor outlook compared to adenocarcinoma, the most common type. NEPC can develop as a new cancer or develop from adenocarcinoma that becomes resistant to hormone therapy.
Researchers are still investigating how best to treat NEPC. There’s currently no standard treatment. Doctors often remove the prostate and use chemotherapy regimens for SCLC, an aggressive type of lung cancer.