Contemporary Incidence and Cancer Control Outcomes of Primary Neuroendocrine Prostate Cancer: A Seer Database Analysis

• Published in: Clinical genitourinary cancer Vol. 15; no. 5; pp. e793 - e800
• Main Authors: Zaffuto, Emanuele, Pompe, Raisa, Zanaty, Marc, Bondarenko, Helen Davis, Leyh-Bannurah, Sami-Ramzi, Moschini, Marco, Dell’Oglio, Paolo, Gandaglia, Giorgio, Fossati, Nicola, Stabile, Armando, Zorn, Kevin C, Montorsi, Francesco, Briganti, Alberto, Karakiewicz, Pierre I
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017
• Subjects: Aged; Carcinoma, Neuroendocrine - epidemiology; Carcinoma, Neuroendocrine - therapy; Carcinoma, Small Cell - epidemiology; Carcinoma, Small Cell - therapy; Hematology, Oncology and Palliative Medicine; Humans; Incidence; Male; Mortality; Neoplasm Metastasis; Neuroendocrine; Prognosis; Prostatectomy; Prostatic neoplasm; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - therapy; Radiotherapy; Retrospective Studies; SEER Program; Small-cell carcinoma; Survival Analysis; Treatment Outcome; United States - epidemiology; Urology; androgen deprivation therapy; small-cell carcinoma; NSCC; RT; neuroendocrine; NEPC; PCa; adjusted incidence; ADT; prostate cancer; non-small cell carcinoma; SCC; radical prostatectomy; NE; radiation therapy; SEER; neuroendocrine prostate cancer; age; RP; PSA; prostate-specific antigen; Prostatic neoplasm; Small-cell carcinoma; Neuroendocrine; Mortality; Incidence
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2017.04.006

Abstract Introduction Neuroendocrine carcinoma of the prostate (NEPC) is a rare entity. We aimed at providing contemporary data on incidence and survival figures of de-novo NEPC. Materials and methods Within the Surveillance, Epidemiology and End Results (SEER) database, we identified 309 individuals with de-novo NEPC diagnosed between 2004 and 2013. We evaluated age-adjusted incidence (AAI) rates over the study. Kaplan-Meier analyses assessed overall survival (OS) after stratification according to histological subtype, metastatic status and treatment. Cox regression analyses tested the predictors of overall mortality (OS), after adjusting for confounders. Results A total of 309 NEPC cases were identified from 510,913 PCa cases. Metastatic disease was identified in 198 (64.1%) cases. The most common histological subtype (n=186; 60.2%) was small cell carcinoma (SCC). The AAI of NEPC significantly increased over the study span. However, this increase only affected SCC (from 0.13/1,000,000 person-years in 2004 to 0.30/1,000,000 person-years in 2013; p=0.001). Median survival for NEPC was 10 months. After stratification according to metastatic status, no difference was observed according to SCC vs. non-SCC (NSCC). Treatment with radical prostatectomy improved OS only among non-metastatic individuals, while radiation therapy did not affect OS rates. In multivariable Cox regression analyses predicting OM, metastatic stage (HR: 1.52; 95% CI: 1.12-2.06; p<0.01) and radical prostatectomy (HR: 0.38; 95% CI: 0.20-0.74; p<0.01) achieved independent predictor status. Conclusion De-novo NEPC is extremely rare and will be encountered in clinical practice by few urologists. Most cases are metastatic at diagnosis. Prognosis is poor regardless of histological type, especially in metastatic stage.