Introduction:
Small cell prostate cancer (SCCp) is an agressive and rare entity. It is frequently associated with prostate adenocarcinoma (CaP) (40-50%).
They share histological features with lung SCC and present as an extensive local disease, visceral disease, low PSA levels despite the advanced metastatic disease, rapid progression and unresponsive to hormonal blockade (HT).
The average time of SCCp development in patients with CaP history is about 18-25 months.
The staging is similar to CaP and the evolution implies a regular follow-up by thoracoabdominal-pelvic CT / MRI and bone scintigraphy.
SCCp is treated the same way pulmonar SCC does. They are both chemosensitive with dim prognosis due to their agressiveness.
Objective, Material, Methods and Results:
History of a 39 years old patient with acinar CaP G6 (3+3) cT2c NxMx, IPSS 3, PSA 6.19, prostatic volume of 24g, Qmax 17ml/s, submitted to I125 low dose Brachytherapy (BT) associated with Radiotherapy (RT) in 2003. He didn´t do HT.
Regular semianually follow-up with PSA nadir of 0.77 ng/ml, 5 years after BT (2009). According to Phoenix criteria, the biochemical failure was declared in August 2014, when its PSA reached 2.77 ng/ml.
In May 2014 the patient reported the appearance of several penile nodes about 0.5 cm in diameter, hard, firm, fixed, painless and persistent. In September 2014 biopsies of these same nodules and of the prostate were made, which showed the same histological result in both: SCCp with penile metastization. A prostatic G8 (4 + 4) focus was also identified at prostate level.
CT and Bone Scintigraphy showed multiple scattered adenopathies, and hepatic, pulmonary and axial skeletal metastases, respectively.
In October 2014 he started QT and 3 months later he developed an urethro-rectal fistula. A suprapubic catheter and a colostomy were done for urinary and fecal derivation, respectively.
The patient died in March 2015 at 52 years old.
Conclusion:
SCCp is a rare and aggressive subtype of prostate carcinoma. It does not usually respond to HT and the progression of the disease is not associated with PSA increases. As in the lung, SCCp is chemosensitive. However, given its rarity, a specific treatment is not standardized. The current published results come from small series, that show an average survival of about 9 months after starting QT.
