We are finding that there are many different types of prostate cancer, all of them are actually different diseases. At Memorial Sloane Kettering Hospital, New York City, they recently announced that, based on genetic analysis, they have identified 23 different types of prostate cancer. One of these cancer types is neuroendocrine prostate cancer which is a very hard to treat form of cancer. This type of cancer behaves differently than most other types of prostate cancer.

Neuroendocrine prostate cancer cells produce hormones themselves including serotonin, bombesin, and calcitonin. Although found in the normal prostate gland we yet do not know the role these cells play in normal prostate biology.

Neuroendocrine cancer cells do not make PSA, they do not grow and they do not have the androgen receptor normally found on other prostate cancer cells. In most prostate cancer neuroendocrine cells are found scattered throughout the cancer tumors. 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 other prostate cancer cells. There are reports that in the prostate cancer specimens obtained at surgery, the prostate cancer cells near the neuroendocrine cells grow more rapidly than those distant from these cells.

This poses the question, Does neuroendocrine cells fuel prostate cancer progression? In fact, the larger the proportion of the cancer mass composed of neuroendocrine cells at diagnosis, the more likely the man will do poorly over time.

Serum chromogranin A has been found to be the best marker to detect the development of neuroendocrine cells in prostate cancer, there is some evidence that it is more than just a marker. 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 1991, Kadmon, et al. showed that an elevated chromogranin A level made evolution of hormone resistance more likely. Also interesting is that once hormonal therapy started, chromogranin A levels initially increased in many men, 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.

However, in small cell carcinoma of the prostate gland the neuroendocrine cells behave a little differently as are able to rapidly grow and spread. Again, these cells make very little or no PSA and have no androgen receptor. While they can make chromogranin A and other neuroendocrine markers, in many cases they make no detectable markers.

Currently, there is no good treatment that has shown efficacy in combating neuroendocrine cells.

A man diagnosed with neuroendocrine prostate cancer needs to see a doctor who has specific knowledge about this form of prostate cancer. I believe that there are two physicians at the University of Rochester Medical Center who have done research in this area. They are Dr. di Sant”Angnese and Dr. Jorge Yao. You might want to arrange for a consultation with one of these doctors if you are facing neuroendocrine prostate cancer.

Joel T Nowak, M.A., M.S.W.