Neuroendocrine differentiation may be seen in a small percentage of advanced prostate cancers – these become hormone resistant and require different treatment.
Frequently have uncharacteristic clinical behaviour – rapidly growing soft tissue involvement or progressive visceral metastases.
Other associations are rapidly progressive retroperitoneal masses, high volume liver metastases, lytic skeletal lesions and brain metastases.
Biopsy often shows small cell variants or poorly differentiated cancers which stain positive for neuroendocrine markers.
PSA is often not expressed by these tumours despite rapid progression.
Treatment is similar to other neuroendocrine tumours like small cell lung cancer – cisplatin and etoposide
Radiation can be effective and should be utilised for local control or in bony mets or critical areas.
Despite high initial response rates, prognosis is poor, with survival generally less than 12 months.