Prostatic small‐cell neuroendocrine carcinoma with disease progression monitored by measurement of serum progastrin‐releasing peptide

Abstract

A 69-year-old man with dif®culty urinating and severe back pain was referred to our department. A physical examination showed a huge prostate and`stony' hard induration palpable in its entirety. Laboratory examinations showed a slightly high serum alkaline phosphatase (ALP) level, but the PSA (2.1 ng/mL) and PAP values were within the normal range. A biopsy specimen from the prostate was identi®ed as moderately to poorly differentiated adenocarcinoma with focal neuroendocrine differentiation (Fig. 1a); immunohistochemical staining was partly positive for PSA in the moderately differentiated component, and positive with chromogranin A (CgA) in the poorly differentiated component, but negative with neurone-speci®c enolase (NSE). The bone scintigram showed multiple bone metastasis, and abdominopelvic CT revealed multiple lymph node metastasis. The level of progastrin-releasing peptide (ProGRP) was up to 737.4 pg/mL (standard value <46.0 pg/mL). Accordingly, disease activity was evaluated in relation to levels of ProGRP and ALP, and clinical images. The patient was treated with hormonal therapy (LHRH analogue and¯utamide) and periodic combination chemotherapy based on cisplatin and adriamycin. The hormonal/chemotherapy was effective in controlling the cancer progression for the ®rst 7 months, but thereafter progression increased, accompanied by high levels of serum ProGRP (Fig. 2) while PSA levels remained a b Fig.

Elevated serum progastrin‐releasing peptide (31–98) in metastatic and androgen‐independent prostate cancer patients*

“…We previously described a case of neuroendocrine cancer of the prostate in which disease progression was monitored by measuring serum ProGRP levels, and GRP appeared to have played a role as an autocrine growth factor [14]. This evidence raised new questions as to whether ProGRP would have potential as a serum neuroendocrine marker in conventional prostate cancer as well.…”

Small-cell prostate carcinoma: A retrospective analysis of five newly reported cases

“…[8] In a case report, progastrin-releasing peptide was followed serially in a patient with SCC of the prostate and normal PSA levels to monitor disease progression. [9] In addition, serum chromogranin A levels were found to correlate with the extent of neuroendocrine differentiation in prostatic carcinomas, though neuron-specific enolase, chromogranin B and pancreastatin did not. [10] Unfortunately in our case series, levels of secretory products were not measured, and the patients clinical courses were only followed by serum PSA measurements, of which 2 were elevated.…”

Small Cell/Neuroendocrine Carcinoma May Be a More Common Phenotype in Advanced Prostate Cancer

“…The serum progastrin-releasing peptide level also responds to SCC phenotype sensitively, even if the tissue is small in amount, and would help in the early detection of SCC [9].…”