2004 Volume 43 Issue 6 Pages 370-375
Background: We report 2 cases of neuroendocrine carcinoma of the prostate, in which tumor cells appeared in the urine.
Cases: 1) A 70-year-old-man diagnosed with poorly differentiated adenocarcinoma by prostate needle biopsy (stage B2), underwent endohormone therapy, after which his serum PSA decreased to the normal range. Two months later, he reported dysuria, and urinary cytology showed a presence of cancer cells, and neuroendocrine carcinoma was detected by prostate needle biopsy. CT and MRI showed invasion of the bladder wall and seminal vesicle. Despite radiotherapy, the patient died of widespread metastasis after a total course of approximately one year. 2) A 74-year-old-man with high PSA was found by biopsy to have moderately differentiated adenocarcinoma, with the tumor was estimated to be stage D1. Endocrine therapy was so effective that the tumor regressed and serum PSA was normalized. Four years later, however, the tumor recurred and urinary cytology was positive for malignant cells. Neuroendocrine carcinoma was detected by prostate needle biopsy. Chemotherapy was administrated combined with radiotherapy, and the tumor responded completely. The man remains recurrencefree in the 5 years since. The same cytological features seen in 2 cases, i. e., high N/ C ratio, naked and hyperchromatic nuclei with finely or coarse granular chromatin, and peculiar cellular arrangement, thus do not necessarily have the same outcome.
Conclusion: It is important to keep in mind that small undifferentiated cells in urinary cytology during follow-up after pros tate cancer suggest an appearance of neuroendocrine carcinoma by the neurodifferentiation of adenocarcinoma cells. It is also important to note the characteristics of nuclei and cellular arrangements.
