November 25, 2014
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Gleason score associated with time to development of neuroendocrine prostate cancer

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Gleason scores among patients with conventional prostatic adenocarcinoma was significantly associated with time to development of treatment-related neuroendocrine prostate cancer, according to study results.

Survival after diagnosis of neuroendocrine prostate cancer was associated with treatment type and the number of organs with metastatic disease, results also showed.

Hai Tao Wang, MD, PhD, of the Tianjin Cancer Hospital and Institute in Tianjin, China, and colleagues conducted a literature review of 54 studies to identify risk factors associated with treatment-related neuroendocrine prostate cancer. The analysis included 123 patients who had a prior history of prostate adenocarcinoma and who had confirmed neuroendocrine prostate cancer (median age at initial diagnosis, 67 years).

The median time to development of neuroendocrine prostate cancer after initial prostate cancer diagnosis was 20 months (range, 1-144). Results of a multivariate analysis indicated a Gleason score ≥8 was the only factor significantly associated with a shorter time to neuroendocrine prostate cancer development (HR=1.66 vs. Gleason score <8; 95% CI, 1.04-2.64).

Median survival after neuroendocrine prostate cancer diagnosis was 7 months (range, 0.5-63).

Multivariate analyses indicated patients who had three or more organs with metastatic disease experienced shorter survival compared with patients who had fewer than three involved organs (HR=3.31; 95% CI, 1.62-6.76).

Survival improved among patients who underwent radiation therapy (HR=0.66; 95% CI, 0.45-0.96), chemotherapy (HR=0.38; 95% CI, 0.17-0.85), or chemotherapy and radiation therapy (HR=0.29; 95% CI, 0.11-0.76) compared with patients who only received palliative therapy.

“Treatment-related neuroendocrine prostate cancer is an often under-recognized late manifestation of prostate adenocarcinoma with poor prognosis,” Wang and colleagues concluded. “Our study found that Gleason score was the only independent factor contributing to time to neuroendocrine prostate cancer. Once neuroendocrine prostate cancer is diagnosed, type of treatment and number of metastatic organs were the most important factors related to survival. Additional studies are necessary to identify specific molecular features of the disease or treatment that may be associated with treatment-associated neuroendocrine prostate cancer.”

Disclosure: The researchers report no relevant financial disclosures.