Santana-Ríos Z, Fulda-Graue S, Pérez-Becerra R, Urdiales-Ortiz A, Morales-Montor J, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 7
Page: 178-180
PDF size: 104.76 Kb.

ABSTRACT

Neuroendocrine differentiation (NED) in prostate cancer has gained in importance due to its prognostic and therapeutic implications. Some authors have related NED degree with poor cellular differentiation, disease progression and androgen-independence.
Objective: The case of a patient diagnosed with prostate cancer in remission with neuroendocrine differentiation and multiple metastatic disease is presented.
Clinical case: The 78-year-old patient presented with prostate adenocarcinoma, Gleason 4+4, 79ng/ml initial PSA and positive scintiscan in May, 2003 (T2bN0M1). He received anti-androgen hormonal treatment and underwent orchiectomy. Patient went into clinical remission with 0.0ng/ml PSA in June 2004 and so anti-androgen was suspended. In January 2008, patient presented with intestinal obstruction and 1.7ng/ml PSA. He underwent exploratory laparoscopy which revealed hepatic nodules and prostate-dependent pelvic mass infiltrating bladder and rectum. Diversion colostomy was performed. Progression was not favorable and the patient died 5 days later. Post-mortem histopathological report stated prostate adenocarcinoma, Gleason 5+5, significant neuroendocrine differentiation and rectum and bladder invasion.
Discussion: Prostate cancer patients with high NED marker levels (chromogranin A) appear to have poor prognosis and can present with poorly differentiated, hormone-resistant tumors. In long-term anti-androgen treatment there is an elevation of neuroendocrine cells, suggesting that hormonal deprivation accelerates the process.
Conclusions: Neuroendocrine differentiation is related to poor prostate cancer prognosis.

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