The increasing incidence of neuroendocrine forms of prostate cancer


A newly published analysis by a research team at Southern Illinois University School of Medicine has teased out some additional information about the well-recognized increase in the incidence of neuroendocrine forms of prostate cancer over the past 20 or so years.

By using a large, national database, Alanee et al. were able to look at a range of factors relevant to the incidence and progression of disease in a cohort of 378 men diagnosed with neuroendocrine forms of prostate cancer between 1992 and 2011, including raw incidence data, age-adjusted incidence rates, mortality rates, and 5-year prostate cancer-specific survival rates.

It is important to understand that neuroendocrine prostate cancers can be divided into two basic groups:

  • Small cell carcinoma of the prostate (SCC-P)
  • Neuroendocrine carcinoma of the prostate (NEC-P)

What Alanee et al. report is the following:

  • The age-adjusted incidence rate of all neuroendocrine prostate cancers has been rising, at about 6.8 percent per year (from 2004 to 2011).
  • The age-adjusted incidence rate of small cell carcinoma of the prostate has also been rising, at about 6.9 percent per year (from 2001 to 2011).
  • The overall, incidence-based mortality rate of men with all neuroendocrine prostate cancers  has been roughly stable since 1992.
  • The overall, incidence-based mortality rates of men with the two subtypes of neuroendocrine prostate cancers (SCC-P and NEC-P) have also been roughly stable since 1992.

What this is telling us is two things:

  • Perhaps because we have become better at treating advanced prostate cancer in general, more men are progressing over time to have SCC-P, which they then die of.
  • There seems to have been little change in the incidence or the mortality rates associated with NEC-P over the past 20 or so years.

These data need to be considered in the context of the paper presented by Small et al. at the annual meeting of the American Society of Clinical Oncology earlier this year. It is clear that we are seeing more patients with neuroendocrine forms of prostate cancer. What is less clear is why most of that increase seems to be driven by a transition from adenocarcinoma to SCC-P in late stage patients (presumably associated in some way with the extensive treatment that these men may receive over time and their associated ability to survive with late stage forms of cancer for longer periods of time).

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