Importance (?) of CgA test for Gleason 8-10

I happened upon an abstract of a study about the relation of neuroendocrine cancer populations on the outcome of prostate adenocarcinoma for Gleason 8-10 cases. To me it suggests that folks like me (G9) should be getting a CgA test to have a better handle on the nature of our cancer. Here's the abstract:

"Prognostic Significance of Neuroendocrine Differentiation in Patients with Gleason Score 8-10 Prostate Cancer Treated with Primary Radiotherapy.
Krauss DJ, Hayek S, Amin M, Ye H, Kestin LL, Zadora S, Vicini FA, Cotant M, Brabbins DS, Ghilezan MI, Gustafson GS, Martinez AA.
Source

Department of Radiation Oncology, Oakland University, William Beaumont School of Medicine, Royal Oak, MI.
Abstract
PURPOSE:

To determine the prognostic significance of neuroendocrine differentiation (NED) in Gleason score 8-10 prostate cancer treated with primary radiotherapy (RT).
METHODS AND MATERIALS:

Chromogranin A (CgA) staining was performed and overseen by a single pathologist on core biopsies from 176 patients from the William Beaumont prostate cancer database. A total of 143 had evaluable biopsy material. Staining was quantified as 0%, <1%, 1-10%, or >10% of tumor cells. Patients received external beam RT alone or together with high-dose-rate brachytherapy. Cox regression and Kaplan-Meier estimates determined if the presence/frequency of neuroendocrine cells correlated with clinical endpoints.
RESULTS:

Median follow-up was 5.5 years. Forty patients (28%) had at least focal positive CgA staining (<1% n = 21, 1-10% n = 11, >10% n = 8). No significant differences existed between patients with or without staining in terms of age, pretreatment prostate-specific antigen, tumor stage, hormone therapy administration, % biopsy core involvement, mean Gleason score, or RT dose/modality. CgA staining concentration independently predicted for biochemical and clinical failure, distant metastases (DM), and cause-specific survival (CSS). For patients with <1% vs. >1% staining, 10-year DM rates were 13.4% vs. 55.3%, respectively (p = 0.001), and CSS was 91.7% vs. 58.9% (p < 0.001). As a continuous variable, increasing CgA staining concentration predicted for inferior rates of DM, CSS, biochemical control, and any clinical failure. No differences in outcomes were appreciated for patients with 0% vs. <1% NED.
CONCLUSIONS:

For Gleason score 8-10 prostate cancer, >1% NED is associated with inferior clinical outcomes for patients treated with radiotherapy. This relates most directly to an increase in distant disease failure."

With 40 out of 143 (28%) having at least focal positive CgA staining, neuroendocrine involvement seems to be more common than I previously thought. Because neuroendocrine cells do not respond to ADT, when adenocarcinoma cells are blocked, these cells continue to multiply. And because they do not produce PSA, they are invisible to standard testing. This abstract and other studies suggest that they may be resistant to radiation therapy.

This suggests that that before considering RT/HDR for Gleason 8-10 cases, one should first have a CgA test.

Nellie

Casey,
Very poorly differentiated adenocarcinomas can acquire neuroendocrine characteristics. That is why it is a good idea to test CgA in blood as a baseline and when PSA might not be a good marker for progression. As you mentioned NE prostate cancer is very resistant to treatment and more so to RT. That is why the study proposes staining of the biopsy cores to determine the presence of NE disease in very poorly differentiated cancers.

Maybe such cancers when present in stained cores could be treated with higher radiation doses that are known to increase cancer cell kill. It is an interesting study in which the presence of NE disease is identified early on by a staining method. I have no idea of the cost or how common is this done in the presence of poorly differentiated PCa. Still it is an interesting contribution by radiation oncology.

RalphV

Thanks Nellie for your contribution!

Devastated,
The source is:
Krauss DJ, Hayek S, Amin M, Ye H, Kestin LL, Zadora S, Vicini FA, Cotant M,
Brabbins DS, Ghilezan MI, Gustafson GS, Martinez AA. Prognostic Significance of
Neuroendocrine Differentiation in Patients with Gleason Score 8-10 Prostate
Cancer Treated with Primary Radiotherapy. Int J Radiat Oncol Biol Phys. 2011 May
17. [Epub ahead of print] PubMed PMID: 21596486.

RalphV

I know this is an old thread, but Husband recently diagnosed with Nueroendocrine Prostate cancer after almost a year of treating. Seems as if this test was done earlier we might be further along in treatment. Any one else have input?

Barb1,
I am sorry this is an old post but was just reading it. How is your husband doing when it comes to neuroendocrine PC? hope he doing fine. Thanks