Clinical Features,diagnosis And Treatment Of Neuroendocrine Prostate Cancer(2 Case Reports And Review Of The Literatures)

Objective: Based on the analysis of the clinical data of patients with neuroendocrine prostate cancer(NEPC)and the review of relevant literature at home and abroad,the epidemiological characteristics,clinical manifestations,pathological features,diagnosis and treatment scheme and prognosis of NEPC were discussed.We hope to provide a reference for clinicians to diagnose and treat the disease.Methods: The clinical data of 2 patients with NEPC admitted to the Second Affiliated Hospital of Chongqing Medical University in 2017-2018 were analyzed retrospectively.We further make a review on the related literatures searched in Pubmed,Embase,Wanfang,Weipu and Cnki databases at home and abroad.Results: The diagnosis of 2 cases was confirmed by pathological biopsy.Case 1 was admitted to hospital due to progressive dysuria with urinary tract irritation sign,newly diagnosed benign prostatic hyperplasia(BPH),and transurethral resection of prostate(TURP)was performedunder lumbar anesthesia after perfect examination.Postoperative pathology:poorly differentiated adenocarcinoma of prostate with neuroendocrine differentiation,Gleason score: 5+5=10 points.After regular castration therapy,severe persistent gross hematuria and bladder blood clot tamponade occurred after 8 months of castration treatment.Finally,he died of advanced tumor complicated with multiple organ failure,and the survival time was 12 months.Case 2 showed left sacrococcygeal pain with anal pain as the main manifestation,his PSA was normal,pelvic MRI showed that the left peripheral zone of the prostate occupied,and prostate biopsy was performed after perfect examination.Postoperative pathology:neuroendocrine carcinoma.After 2 cycles of chemotherapy with EP regimen,the tumor was slightly larger than that before chemotherapy,and the effect of chemotherapy was poor.After that,ultrasound-guided prostate particle implantation was performed,forever,the tumor was still progressive after 1 month of brachytherapy,and distant organ metastasis occurred.The patients were followed up regularly for 17 months and survived with tumor.Conclusion: NEPC is rare in clinic,unknown in origin,lack of characteristic clinical manifestations and poor prognosis.Endocrine therapy increased the proportion of prostate cancer with neuroendocrine differentiation and treatment-emergent NEPC.Prostate mass can be found by imaging examination,but it is not specific for diagnosis.The finaldiagnosis depends on its pathological features and immunophenotype.Early diagnosis and multidisciplinary comprehensive treatment combined with radiotherapy and chemotherapy can improve the survival rate of some patients.In the future,inhibition and reversal of NEPC or neuroendocrine differentiation from molecular mechanisms will become an important new therapeutic strategy.