Big problems lie in small cells.

Prostate cancer is just full of surprises. One such surprise is small cell neuroendocrine carcinoma. This entity is rare, much more aggressive, and usually associated with a paradoxically low PSA. But this study demonstrates it may not be as rare as we think. It takes an in-depth look at biopsy specimens from men with metastatic, castration-resistant prostate cancer (mCRPC) with no prior history of small cell carcinoma. Turns out 17% of these men developed treatment-emergent small cell neuroendocrine prostate cancer while on androgen deprivation. These tumors had aggressive features, were biologically distinct from other metastatic prostate cancers, and were associated with worse overall survival. TBL: Nearly one in five of men with mCRPC harbor treatment-emergent small cell neuroendocrine prostate cancer, which may call for a whole new molecular paradigm of salvage treatment options. | Aggarwal, J Clin Oncol 2018