Urologic Oncology: Seminars and Original Investigations
Review articlePrognostic effect of neuroendocrine differentiation in prostate cancer: A critical review
Introduction
Neuroendocrine differentiation (NED) is commonly present in the prostate gland, and its mechanisms have been studied extensively in the literature [1], [2]. Nevertheless, multiple pathways are involved in the NED phenomenon and remain still unclear. Evidence suggests that several environmental triggers induce NED in prostate cancer (PCa), leading to the adaptation of PCa to its close environment to maintain cell proliferation. Thus, NED, an androgen-independent phenomenon, allows tumor cell growth under androgen-deprivation therapy (ADT) and may represent a viable option to escape hormone therapy and, thus, to contribute to cancer progression, mainly at castration-resistant stage. The functional network between adenocarcinoma cells and neuroendocrine (NE) cells may play an important role and may be the key mechanism in therapy and castration resistance, leading to disease progression.
In this review, we aimed to summarize all available data about NED and to assess the potential prognostic role of such differentiation in disease progression and therapy resistance and its role in routine clinical practice.
Section snippets
Methods
This review is based on articles found through a PubMed literature search between January 1, 1993 and December 31, 2013, using the following search terms: neuroendocrine differentiation, prostate cancer, ionizing radiation, androgen-deprivation therapy, chemotherapy, prognosis, immunohistochemistry, radical prostatectomy, and androgen therapy. The search terms were used one at a time and simultaneously in various combinations. Eventually, 1,270 articles were selected. Case reports, letters, or
Nonmalignant prostate gland
NE cells are present in normal prostate gland and were originally described by Pretl in 1944 [3], [4]. They represent the third type of epithelial cell in the prostate gland after basal and exocrine secretory cells and account for<1% of all normal prostate cells. The role of NE cells is to regulate the cell growth and secretory activity via a paracrine mechanism [5]. However, the exact pathways underlying this regulation, as well the exact origin (neurogenic or stem cell origin) of these NE
Conclusions
Evidence contributes that NED in PCa that bears witness of the PCa adaptation to an androgen-deprived environment contribute to cancer progression. In clinical practice, immunostaining for NE markers could have interesting predictive value for assessing the oncologic outcomes in patients at castration-resistant stage and might promote more aggressive treatment strategies targeting NED pathways. Conversely, strong evidence is lacking concerning its potential independent prognostic value in
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2019, Urology Case ReportsCitation Excerpt :NSE is a generic marker of NEC with high sensitivity but low specificity. Periodic NSE measurement can monitor NEDPC progression and may be considered for early detection in patients with CRPC, although the routine use of neuroendocrine markers in early stage PC is not recommended.2,4 In our patient, periodic PSA assays per 3 or 6 months and CT scan per 1 or 2 years did not detect disease progression; however, elevated serum NSE level reflected disease progression.
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2018, Pathology Research and PracticeCitation Excerpt :Of these three markers, CgA appears to be the most specific in detecting NED and predicting the prognosis of PCa [12]. The incidence of NED in primary prostate tumors and its effect on clinical outcome has been examined in several previous studies [2,10,11]. However, although NED in primary PCa is associated with higher incidence of metastatic disease, few articles have focused on NED in metastatic tumor sites.