VALUE OF THE DETECTION OF NEUROENDOCRINE DIFFERENTIATION IN PROSTATE CANCER

Background. Many investigators point out the importance of detecting the neuroendocrine differentiation of prostate adenocarcinoma (PA) and consider its relationship to the clinical picture of the disease and total Gleason scores (Gleason index).

Objective: to study relations between the presence of markers indicative of neuroendocrine differentiation in PA tissue, Gleason index, and disease characteristics.

Materials and methods. The fragments of the postoperative histological specimens obtained from 30 patients after radical prostatectomy in 2008 were stained by an immunohistochemical assay to identify specific markers of neuroendocrine differentiation: chromogranin A (CgA) and synaptophysin. The expression of the markers of neuroendocrine differentiation was compared to the clinical stage of the disease and Gleason index that was used to allocate the patients to 3 groups: low-, moderate-, and high-grade tumors.

Results. The patients» mean age was 67 ± 9.2 years. Groups 1, 2, and 3 included 5, 19, and 6 patients, respectively. The expression of CgA was found in 10 % of Group 1 patients, in 33 % in Group 2, and in 40% in Group 3. CgA expression considerably increased with a higher Gleason score (p = 0.024).

Conclusion. The expression of CgA is more than that of other used markers and correlates with the clinically determined stage of the disease. The expression of CgA increases with a higher grade, which can be potentially used to predict the course of the disease. The limitations of this investigation are associated with its retrospective pattern and a small sample size. The findings need to be clarified in a large cohort study.

1. Jemal A., Siegel R., Ward E. et al. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43–66.

2. di Sant'Agnese P.A. Neuroendocrine differentiation in carcinoma of the prostate. Diagnostic, prognostic, and therapeutic implications. Cancer 1992;70:254–68.

3. Bostwick D.G., Foster C.S., Algaba F. et al. Prostate tissue factors. In: Prostate cancer. Second international consultation on prostate cancer. Plymouth: Plymbridge Distributors, 2000;162–201.

4. Ather M.H., Shariff A.H. Prognostic and therapeutic value of neuroendocrine differentiation as manifested by chromogranin A in prostate carcinoma. In: Prostate cancer. Nova science Publishers, New York, 2004.

5. Ather M.H., Abbas F., Faruqui N. et al. Expression of pS2 in prostate cancer correlates with grade and Chromogranin A expression but not with stage. BMC Urol 2004;4:14–7.

6. Lijovic M., Fabiani M.E., Bader J., Frauman A.G. Prostate cancer: are new prognostic markers on the horizon? ProstCanc Prost Dis 2000;3:62–5.

7. Montironi R., Schulman C.C. Precursors of prostate cancer, progression, regression and chemoprevention. Eur Urol 1996;30:133–7.

8. Di Sant'Agnese P.A. Divergent neuroendocrine differentiation in prostatic carcinoma. Semin Diagn Pathol 2000;17(2):149–61.

9. Kamiya N., Suzuki H., Kawamura K. et al. Neuroendocrine differentiation in the progression of prostate cancer. Int J Urol 2008;15:423–8.

10. Dauge M.C., Delmas V. A.P.U.D. type endocrine tumour of the prostate. Incidence and prognosis in association with adenocarcinoma. Prog Clin Biol Res 1987;243A:529–31.

11. Cohen R.J., Glezerson G., Haffejee Z. Neuro-endocrine cells – a new prognostic parameter in prostate cancer. Br J Urol 1991;68:258–62.

12. Bostwick D.G., Dousa M.K., Crawford B.G., Wollan P.C. Neuroendocrine differentiation in prostatic intraepithelial neoplasia and adenocarcinoma. Am J Surg Pathol 1994;18:1240–6.

13. Noordzij M.A., Kwast T.H. van der, van Steenbrugge G.J. et al. The prognostic influence of neuroendocrine cells in prostate cancer: results of a long-term follow-up study with patients treated by radical prostatectomy. Int J Cancer 1995;62:252–8.

14. Abrahamsson P.A., Cockett A.T., di Sant'Agnese P.A. Prognostic significance of neuroendocrine differentiation in clinically localized prostatic carcinoma. Prostate Suppl 1998;8:37–42.