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Adenocarcinoma Recurring As Small Cell Anaplastic After HT

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Posted 2/28/2014 5:27 AM (GMT 0)
Is anyone familiar with this? If so, how was it detected that the adenocarcinoma recurred as small cell anaplastic cancer and what triggered the reason for small cell detection?

I know that when adenocarcinoma cells become hormone resistant, the PSA normally goes up.

How do you know when pulling zero's is not a good thing?

Any thoughts appreciated.


"Small cell carcinoma of the prostate is a high-grade malignant neoplasm with neuroendocrine differentiation. The morphologic features characteristic of the disease's pathology include small tumor cells with minimal cytoplasm, nuclear molding, fine chromatin pattern, extensive tumor necrosis/apoptosis, and a brisk mitotic rate.

Small cell carcinoma of the prostate is rare, accounting for less than 1% of all prostate cancers. Approximately 50% of patients have pure small cell carcinoma at initial presentation. Some 25-50% of cases are mixed with a conventional prostatic adenocarcinoma. 2. Another 25-40% of cases are initially diagnosed as prostatic adenocarcinoma and recur as small cell carcinoma after hormonal therapy. The median interval between initial diagnosis of prostatic adenocarcinoma and recurrence of small cell carcinoma is 25 months. Unlike prostatic adenocarcinoma, small cell carcinoma of the prostate may present with metastases in up to 25% of patients."

emedicine.medscape.com/article/1611899-overview

"Prostatic small cell carcinomas may pursue similar routes as prostatic adenocarcinomas to spread to other parts of the body. They may invade through the prostatic capsule to involve the periprostatic soft tissue, seminal vesicles, bladder neck, and rectum locally. They may also metastasize to the pelvic lymph nodes, periaortic lymph nodes, bone, liver, adrenal glands, lung, and brain. As such tumors are more aggressive, they tend to spread much earlier. Therefore, they typically present at a higher pathologic stage than prostatic adenocarcinomas."

emedicine.medscape.com/article/1611899-overview#aw2aab6b8

Post Edited (MsWorryWart) : 2/28/2014 6:47:20 PM (GMT-7)

Posted 2/28/2014 11:48 AM (GMT 0)
Maria,

I have read about this and one of my clients experienced it. He fought PCa for nearly 9 years. It started out with a low PSA and high Gleason. When he was dx he had a bad abdominal lymph node. He went through several different treatments including several rounds of HT, chemo, DES, and paid out of pocket for 6 months of Zytiga. In the end the killer was small cell in his lung.

Unfortunately, many cancers morph and change dramatically in response to treatment.....kind of "what doesn't kill me makes me stronger". My niece had a rare aggressive apendiceal cancer that first presented as many large firm tumors throughout her abdomen. They were removed and treated with chemo. Several months later they came back as very small poppy seed like tumors and were again treated with chemo. The third strike was when it came back in a mucinous form and there was no treating it.

I have not read how prevalent such responses are or how related they are to the initial dx or treatment protocol.

Jack
Posted 2/28/2014 12:52 PM (GMT 0)
Hi Mrs WorryWart.

I am hoping that you just read about this by chance and that Mr WorryWart has not been diagnosed as one of the 1%.

See you next month, or tomorrow we can say later this month.

LupronJim
Posted 2/28/2014 4:52 PM (GMT 0)
Thanks JNF... Sorry to hear about your niece.

Jim,
The oncologist did mention this as something he will be watching for.
As I recall, he was in the 1% group for his age and metastasis when diagnosed.

He'd much prefer to hit the 1% for the lottery! :)
Posted 2/28/2014 8:25 PM (GMT 0)
There is very new science on the phenomenon of "acquired resistence" where adenocarcinoma actually transforms from one variety to another. It has been studied fairly extensively in the context of non-small cell adenocarcinoma of the lung tranforming to small cell lung cancer, but is now being discussed in other cancer contexts. I have seen nothing on Pca but expect that molecular genetic testing of certain expressions will ultimately yield findings that the cells ultimately outsmart the treatment and morph into another type over time. Lecia Sequist, M.D. of Harvard-Mass General is a leading investigator of this phenomenon.
Posted 3/1/2014 12:03 AM (GMT 0)
bump
Posted 3/1/2014 5:30 AM (GMT 0)
Thank you, AJ 47. I've researched some of her papers, but not yet able to find anything regarding Pca.
Mr. WW's oncologist specifically mentioned "anaplastic."

So far, this is all I was able to find that was fairly recent and quite frankly, I've read it at least 20 times and don't understand anything more than after the 1st read.

www.ncbi.nlm.nih.gov/pubmed/23358695

But, I'm still looking... :)
Posted 3/1/2014 5:30 AM (GMT 0)
Thanks again, Logo! :)
Posted 3/1/2014 5:47 AM (GMT 0)
I have to ask Msww, has your husband been diagnosed with anaplastic Pca? Im confused by your response to JNF. Also I read your link and only got that 1% of pca was anaplastic. I hope I am not being personal, and I hope it is just something your oncologist is putting on his watch list. And your welcome, you are.
Posted 3/1/2014 5:56 AM (GMT 0)
It just occurred to me that the oncologist mentioned that he was in a group that wrote a paper on this...

I found it... And, this one is a little too easy to read.... but I have huge faith, that "suspects" is not "is!"

www.ncbi.nlm.nih.gov/pubmed/23649003
Posted 3/1/2014 6:31 AM (GMT 0)
Logo,

I was replying with the new link when you posted and I did not see it.

His oncologist is just putting it on his watch list.

He wants to take him off of all medications in 6 months. He feels that the risk is greater than the reward at this point, due to side effects and taxing his organs/body in general.

We'll know soon enough. His last PSA was .015, so we'll see what happens when he gets off of the Lupron, Casodex, and Zytiga.

I am kind of thinking that the oncologist saw how gloomy his prognosis was at diagnosis and for him to be pulling zeros is "suspect."

We "suspect" the power of prayer trumps all. :)

But, I have to know about this stuff...just in case, or I wouldn't be "MsWorryWart!" :)
Posted 3/1/2014 5:10 PM (GMT 0)
Thats exactly the answer I was hoping for and suspected, but wasn't sure. yea my oldest son's middle name is Justin……… Justin case we forget his first …..Bonk!
Posted 3/1/2014 5:24 PM (GMT 0)
A young man (early 40s) in my support group has small cell PC -- devastating. He is able to keep it under control with Taxotere so far. In his case, it is a mixed type, which sometimes occurs. I don't know if the cancer "morphs." It seems more likely to me that the ADT differentially kills off the normal hormone-responsive cancer, leaving the small cell cancer to proliferate and become more detectable. In many ways, it is more similar to small cell lung cancer than to prostate cancer.

- Allen
Posted 3/2/2014 12:42 AM (GMT 0)
LOL...Logo!

Tall Allen,

Thank you! That makes sense that only the small cells would be left behind, or the most prominent. Perhaps I used the word "morphed," inappropriately, even though it made sense in my mind. LOL

I also read the same things about it becoming more similar to small cell lung cancer than to prostate cancer. Certainly some interesting, albeit, frightening articles out there.

Thanks again!
Posted 3/2/2014 1:25 AM (GMT 0)
Msww,

You said, "I am kind of thinking that the oncologist saw how gloomy his prognosis was at diagnosis and for him to be pulling zeros is "suspect."

From the cases I've seen over the years for guys who have psa negative disease (where psa is unreliable as a cancer marker), usually they have had a low psa at diagnosis and they are usually Gleason 9 or 10.

I think him pulling zeros is more indicative of a great response to treatment

I'm suspect as well given my low psa at diagnosis and when a bone met was found. Because of this I get a bunch of other things checked monthly and scans every 6 months.

My hope is that in 6 months I can welcome him into the world of IHT.

Jerry
Posted 3/3/2014 5:53 AM (GMT 0)
Thanks, Jerry!

Yes... we are absolutely are hoping for the IHT club!

We believe in the power of prayer...
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