Aggressive variants of castration-resistant prostate cancer.
Aggressive variants of castration-resistant prostate cancer.
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DOI：
10.1158/1078-0432.ccr-13-3309
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发表时间：
2014-06-01
期刊：
影响因子：
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通讯作者：
Rubin MA
中科院分区：
文献类型：
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作者：
Beltran H;Tomlins S;Aparicio A;Arora V;Rickman D;Ayala G;Huang J;True L;Gleave ME;Soule H;Logothetis C;Rubin MA
一部分晚期去势抵抗性前列腺癌（CRPC）患者可能最终演变为雄激素受体（AR）非依赖性表型，临床表现与累及内脏部位和激素不应性的快速进展性疾病相关，通常在血清前列腺特异性抗原（PSA）水平较低或适度升高的情况下发生。在这些患者中进行的活检可能会有所不同，从低分化癌到混合腺癌-小细胞癌到纯小细胞癌。这些侵袭性肿瘤通常表现出低或缺乏AR蛋白表达，并且在某些情况下表达神经内分泌分化的标志物。由于肿瘤形态并不总是由临床行为预测，术语“间变性前列腺癌”或“神经内分泌前列腺癌”已被用来描述这些快速增长的临床特征。符合间变性前列腺癌临床标准的患者已被证明预测预后不良，这些患者可考虑接受基于铂的化疗治疗方案。因此，了解晚期前列腺癌谱内的变异具有重要的诊断和治疗意义。
A subset of patients with advanced castration resistant prostate cancer (CRPC) may eventually evolve into an androgen receptor (AR) independent phenotype, with a clinical picture associated with the development of rapidly progressive disease involving visceral sites and hormone refractoriness, often in the setting of a low or modestly rising serum prostate specific antigen (PSA) level. Biopsies performed in such patients may vary, ranging from poorly differentiated carcinomas to mixed adenocarcinoma-small cell carcinomas to pure small cell carcinomas. These aggressive tumors often demonstrate low or absent AR protein expression, and in some cases express markers of neuroendocrine differentiation. Since tumor morphology is not always predicted by clinical behavior, the terms “anaplastic prostate cancer” or “neuroendocrine prostate cancer” have been employed descriptively to describe these rapidly growing clinical features. Patients meeting clinical criteria of anaplastic prostate cancer have been shown to predict for poor prognosis, and these patients may be considered for platinum based chemotherapy treatment regimens. Therefore, understanding variants within the spectrum of advanced prostate cancer has important diagnostic and treatment implications.