Proposed Morphologic Classification of Prostate Cancer With Neuroendocrine Differentiation

TLDR

Recent clinical and molecular findings in prostate cancer treated with contemporary androgen‑deprivation therapies highlight the need to refine diagnostic terminology to encompass the full spectrum of neuroendocrine differentiation. The study seeks to define refined diagnostic criteria for neuroendocrine differentiation in prostate cancer, aiming to produce clinically relevant pathologic diagnoses that will guide targeted therapy development. The authors propose a classification system that includes usual adenocarcinoma with neuroendocrine differentiation, adenocarcinoma with Paneth‑cell neuroendocrine differentiation, carcinoid tumor, small‑cell carcinoma, large‑cell neuroendocrine carcinoma, and mixed neuroendocrine carcinoma with acinar adenocarcinoma.

Abstract

On July 31, 2013, the Prostate Cancer Foundation assembled a working committee on the molecular biology and pathologic classification of neuroendocrine (NE) differentiation in prostate cancer. New clinical and molecular data emerging from prostate cancers treated by contemporary androgen deprivation therapies, as well as primary lesions, have highlighted the need for refinement of diagnostic terminology to encompass the full spectrum of NE differentiation. The classification system consists of: Usual prostate adenocarcinoma with NE differentiation; 2) Adenocarcinoma with Paneth cell NE differentiation; 3) Carcinoid tumor; 4) Small cell carcinoma; 5) Large cell NE carcinoma; and 5) Mixed NE carcinoma - acinar adenocarcinoma. The article also highlights "prostate carcinoma with overlapping features of small cell carcinoma and acinar adenocarcinoma" and "castrate-resistant prostate cancer with small cell cancer-like clinical presentation". It is envisioned that specific criteria associated with the refined diagnostic terminology will lead to clinically relevant pathologic diagnoses that will stimulate further clinical and molecular investigation and identification of appropriate targeted therapies.