A comprehensive review of incidence and survival in patients with rare histological variants of prostate cancer in the United States from 1973 to 2008

Abstract

BACKGROUND:The American Joint Commission on Cancer (AJCC) identifies five rare variants of prostate adenocarcinoma: mucinous, ductal, signet ring cell, adenosquamous and neuroendocrine including small cell. No prior study has comprehensively detailed incidence and outcomes for all AJCC variants of prostate cancer. METHODS: We used the Surveillance, Epidemiology and End Results (SEER) program to analyze prostate cancers diagnosed from 1973 to 2008. Cases of mucinous, ductal, signet ring cell, adenosquamous and neuroendocrine carcinoma were identified, along with cases of non-variant adenocarcinoma for comparison. Age-adjusted incidence rates (IRs) and overall survival (OS) were evaluated and stratified by race, age, stage and PSA. All IRs represent the number of cases per million people per year. RESULTS: Each variant is rare, with IRs between 0.03 (adenosquamous) and 0.61 (mucinous). There was a significant difference in incidence between Caucasian and African American patients with mucinous adenocarcinoma. Median OS varied ranged from 10.0 months in neuroendocrine carcinoma to 125.0 months in mucinous adenocarcinoma. In all, 5-year OS ranged from 12.6% in neuroendocrine carcinoma to 75.1% in mucinous adenocarcinoma. There was a significant difference in survival between Caucasian and African American patients for mucinous adenocarcinoma (median survival 144.0 vs 99.0 months, Po0.01). African American patients with mucinous adenocarcinoma also presented with more advanced stage disease compared with Caucasian patients. Multivariate analysis demonstrated that African American race was not associated with worse survival when corrected for stage. CONCLUSIONS: There are differences in IRs and OS among rare variants of prostate cancer. For mucinous adenocarcinoma, there are significant differences in incidence and survival between Caucasian and African American patients. These differences should be considered in clinical decision making for patients with these malignancies.

The Role of Epigenetics and Long Noncoding RNA MIAT in Neuroendocrine Prostate Cancer

“…In addition, no treatment has demonstrated efficacy in extending the survival of NEPC patients. While median prostate adenocarcinoma survival is 125 months, median NEPC survival is only 7 months [18,19]. Hence, the phenotypic distinction between NEPC and adenocarcinoma is extremely important from a clinical perspective.…”

Prostate Cancer Registries: Current Status and Future Directions

“…In the five Nordic countries, an analysis of incidence and mortality data revealed a rapid increase in PCa incidence during the early 1990s coinciding with the introduction of PSA testing, while mortality rates stabilized or declined in countries where PSA testing and curative treatment have been commonly practiced since the late 1980s [52]. In addition, tumor registries can provide incidence and mortality data on patients with rare histologic subtypes that are not included in RCTs or institutional cohorts [53]. Cancer registries are also used to examine differences in incidence and mortality rates according to patient characteristics such as age, comorbidity status, race, socioeconomic status, and disease severity [54][55][56][57][58][59].…”

Rapid progression of mixed neuroendocrine carcinoma-acinar adenocarcinoma of the prostate: A case report

“…Tanaka et al (14) reported the following characteristics for the clinical course of NE prostate cancer: i) Survival time is short subsequent to relapse; ii) PSA levels do not increase subsequent to relapse; and iii) the metastatic sites are similar to those of common adenocarcinomas. Marcus et al (15) reported a median survival time of 10 months for patients with NE tumors and a 5-year overall survival rate of 12.6%. Given that NE prostate cancer is independent of AR signaling, combination chemotherapy must be added to the current therapeutic regimen.…”

“…The majority of NEPCs originate from conventional prostatic adenocarcinoma, and mixed NE carcinoma-acinar adenocarcinomas of the prostate are formed (2). Marcus et al (3) identified 502 cases of NE carcinoma and this study showed that the 5-year overall survival of NE carcinoma was 12.6% while the 5-year overall survival for non-variant prostate adenocarcinoma was 76.5%. More than one-half of patients presented with metastatic disease at diagnosis and the prognosis of NEPCs was poor.…”