In my clinic, American Diseases of the Prostate, as in any clinic that sees a large number of prostate cancer patients, I've encountered prostate cancers that deviate from the well-established behavior of the common adenocarcinoma. One of those unusual forms of prostate cancer is neuroendocrine carcinoma.
Neuroendocrine cells are found in the normal prostate gland, where they have been shown to produce a range of hormones including serotonin, bombesin, and calcitonin. However, we do not know the role these neuroendocrine cells play in normal prostate biology. In the standard adenocarcinoma of the prostate gland, neuroendocrine cells are nearly always found scattered throughout the cancer mass. In the test tube, even though the neuroendocrine cells do not grow, the hormones produced by these cells are capable of fueling the growth of the adenocarcinoma cells. One report claimed that in the prostate cancer specimens obtained at surgery, the prostate cancer cells near the neuroendocrine cells were growing more rapidly than those distant from these cells. This suggests that the neuroendocrine cells might fuel prostate cancer progression. In fact, the larger the proportion of the cancer mass composed of neuroendocrine cells at diagnosis, the more likely the patient would do poorly over time.
For example, if you add chromogranin A to prostate cancer in tissue culture, it triggers the formation of proteins that improve the cancer cell's resistance to treatment. In prostate cancer research, there are certain classic studies that define issues with great clarity. In 1991, Kadmon, et al. showed that an elevated chromogranin A level made evolution of hormone resistance more likely. Furthermore, once hormonal therapy started, chromogranin A levels initially increased in many patients, but would later decline back to normal. When chromogranin A levels stayed elevated or when it started to increase late in hormonal therapy, hormone resistance was very likely to follow. This observation has been repeatedly confirmed.
Up to this point, we have been discussing the impact of neuroendocrine cells that are not themselves capable of growth and where the impact appears to be thought an effect on the prostatic adenocarcinoma cells. In small cell carcinoma of the prostate gland we have neuroendocrine cells that are able to rapidly grow and spread. Again, these cells make very little or no PSA and make little or no androgen receptor. While they can make chromogranin A and other neuroendocrine markers, in many cases they make no detectable markers.
Prostate Cancer Research and Treatment
As the most common cancer in men in the United States, prostate cancer affects thousands of men. Prostate cancer research aims to raise money and awareness to contribute towards improving treatment and finding a cure or cures for this disease.
Prostate cancer is extremely rare in men under 45, it commonly affects men in their 50's and is most often diagnosed in men in their 70's.
As yet there are no cures for prostate cancer, so research looks into this, as well as improving the conditions for men currently suffering from prostate cancer. Research also looks at how to improve the current treatments and how to prevent the cancer from reoccurring after treatment.
The prostrate gland is located between the bladder and rectum and is part of the male reproductive system. The prostate gland is used in the production and storage of seminal fluid.
The current treatments for prostate cancer depend on if the cancer has metastasized (spread) to other parts of the body, especially to the bones or lymph nodes, or not. If the cancer is still contained within the prostate then radiation therapy can be undertaken to kill the cancer cells with x-rays.
A radical prostatectomy can also be performed. This is surgery to remove the entire prostate gland. If the surgery is successful and the cancer is all removed then the likelihood of a recurrence is low. Recurrence of the cancer is slightly higher if radiation therapy is undertaken.
If the cancer has spread outside of the prostate gland then radiation therapy and radical prostatectomy are no longer treatment options. Hormone therapy can be undertaken to limit the growth of the hormone. Research has shown that prostate cancer growth is linked to male hormones called androgens.
Androgens, such as testosterone, are produced in the testicles and these hormones can cause the tumor to grow very quickly which increases the risk of the cells spreading. Therefore by limiting the amount of male hormones, you can slow the growth of the tumor. This can be done by medication, although sometimes the testicles are removed to assist the hormone treatment.
The other treatment option is called 'watchful waiting' or 'active surveillance'.
It is hoped that with continued prostate cancer research that treatments will exist and more options will become available, especially to reduce the incidence of reoccurrence after treatment. The eventual aim of prostate cancer research is to find a cure for this deadly disease.
Neuroendocrine cells are found in the normal prostate gland, where they have been shown to produce a range of hormones including serotonin, bombesin, and calcitonin. However, we do not know the role these neuroendocrine cells play in normal prostate biology. In the standard adenocarcinoma of the prostate gland, neuroendocrine cells are nearly always found scattered throughout the cancer mass. In the test tube, even though the neuroendocrine cells do not grow, the hormones produced by these cells are capable of fueling the growth of the adenocarcinoma cells. One report claimed that in the prostate cancer specimens obtained at surgery, the prostate cancer cells near the neuroendocrine cells were growing more rapidly than those distant from these cells. This suggests that the neuroendocrine cells might fuel prostate cancer progression. In fact, the larger the proportion of the cancer mass composed of neuroendocrine cells at diagnosis, the more likely the patient would do poorly over time.
For example, if you add chromogranin A to prostate cancer in tissue culture, it triggers the formation of proteins that improve the cancer cell's resistance to treatment. In prostate cancer research, there are certain classic studies that define issues with great clarity. In 1991, Kadmon, et al. showed that an elevated chromogranin A level made evolution of hormone resistance more likely. Furthermore, once hormonal therapy started, chromogranin A levels initially increased in many patients, but would later decline back to normal. When chromogranin A levels stayed elevated or when it started to increase late in hormonal therapy, hormone resistance was very likely to follow. This observation has been repeatedly confirmed.
Up to this point, we have been discussing the impact of neuroendocrine cells that are not themselves capable of growth and where the impact appears to be thought an effect on the prostatic adenocarcinoma cells. In small cell carcinoma of the prostate gland we have neuroendocrine cells that are able to rapidly grow and spread. Again, these cells make very little or no PSA and make little or no androgen receptor. While they can make chromogranin A and other neuroendocrine markers, in many cases they make no detectable markers.
Prostate Cancer Research and Treatment
As the most common cancer in men in the United States, prostate cancer affects thousands of men. Prostate cancer research aims to raise money and awareness to contribute towards improving treatment and finding a cure or cures for this disease.
Prostate cancer is extremely rare in men under 45, it commonly affects men in their 50's and is most often diagnosed in men in their 70's.
As yet there are no cures for prostate cancer, so research looks into this, as well as improving the conditions for men currently suffering from prostate cancer. Research also looks at how to improve the current treatments and how to prevent the cancer from reoccurring after treatment.
The prostrate gland is located between the bladder and rectum and is part of the male reproductive system. The prostate gland is used in the production and storage of seminal fluid.
The current treatments for prostate cancer depend on if the cancer has metastasized (spread) to other parts of the body, especially to the bones or lymph nodes, or not. If the cancer is still contained within the prostate then radiation therapy can be undertaken to kill the cancer cells with x-rays.
A radical prostatectomy can also be performed. This is surgery to remove the entire prostate gland. If the surgery is successful and the cancer is all removed then the likelihood of a recurrence is low. Recurrence of the cancer is slightly higher if radiation therapy is undertaken.
If the cancer has spread outside of the prostate gland then radiation therapy and radical prostatectomy are no longer treatment options. Hormone therapy can be undertaken to limit the growth of the hormone. Research has shown that prostate cancer growth is linked to male hormones called androgens.
Androgens, such as testosterone, are produced in the testicles and these hormones can cause the tumor to grow very quickly which increases the risk of the cells spreading. Therefore by limiting the amount of male hormones, you can slow the growth of the tumor. This can be done by medication, although sometimes the testicles are removed to assist the hormone treatment.
The other treatment option is called 'watchful waiting' or 'active surveillance'.
It is hoped that with continued prostate cancer research that treatments will exist and more options will become available, especially to reduce the incidence of reoccurrence after treatment. The eventual aim of prostate cancer research is to find a cure for this deadly disease.
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