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