P. Anthony di Sant'Agnese

Neuroendocrine differentiation in carcinoma of the prostate. Diagnostic, prognostic, and therapeutic implications

Endocrine-paracrine cells of the prostate (also known as APUD or neuroendocrine cells) constitute, in addition to the basal and exocrine secretory cells, a third population of highly specialized epithelial cells in the prostate gland. These endocrine-paracrine cells contain, and most likely secrete, serotonin and calcitonin, as well as variety of other peptides. Little is known of the functional role of these cells, but they probably subserve a paracrine or local regulatory role. They may also regulate via endocrine, lumencrine, or neurocrine mechanisms. These endocrine-paracrine cells probably play a significant role during prostatic growth and differentiation as well as regulating the secretory process of the mature gland. Neuroendocrine differentiation in prostatic carcinoma occurs in the form of the relatively rare small cell carcinoma and carcinoid or carcinoid-like tumor, but most commonly as focal neuroendocrine differentiation in a conventional prostatic adenocarcinoma that is a very frequent, if not ubiquitous phenomenon, and reflects tumor cell heterogeneity mimicking the normal differentiation process. The worlds literature on neuroendocrine differentiation in prostatic carcinoma is reviewed. Neuroendocrine differentiation in all types of prostatic carcinoma appears to correlate with a poor prognosis. This correlation is probably multifactorial and may relate to a positive correlation with grade, a direct resistance to hormonal manipulation, and/or autocrine/paracrine growth factor activity due to the secretion of neuroendocrine products. Neuron-specific enolase and chromogranin, as well as other neuroendocrine products, may be useful as serum markers in patients with prostatic carcinoma with neuroendocrine differentiation. New therapeutic strategies need to be developed to treat these tumors. This includes the use of specialized protocols that have been effective against neuroendocrine carcinomas arising in other organ systems.

Neuroendocrine differentiation in human prostatic carcinoma

Abstract Endocrine-paracrine (APUD, neuroendocrine) cells are located in the prostatic ductal and acinar epithelium. These cells are of the open and closed type and have dendritic processes. There is a wide range of secretory granule morphology presumably indicating a variety of different cell “type.” Secretory immunoreactive peptides include serotonin, calcitonin (and related peptides), somatostatin, bombesin-like, thyroid-stimulating hormone-like (beta chain), and alpha-glycoprotein chain-like. These cells may function by endocrine, paracrine, neurocrine, and lumencrine mechanisms and play an important regulatory role both during growth and differentiation of the prostate as well as in the secretory process of the mature gland. Neuroendocrine differentiation in prostatic carcinoma is a frequent occurrence and manifests itself in several forms, including (1) small cell carcinoma, (2) carcinoid and carcinoid-like tumors, and (3) conventional adenocarcinoma with focal neuroendocrine differentiation. This latter pattern is the most common, and there is evidence that all or nearly all prostatic adenocarcinomas show at least some focal neuroendocrine differentiation. A review of the worlds literature on this topic is included. Neuroendocrine differentiation generally portends a poorer prognosis but may also correlate directly with the grade. There is some evidence to suggest that neoplastic cells with neuroendocrine differentiation are resistant to hormonal therapy. Europic and ectopic hormone production may allow screening for prostatic carcinoma and/or monitoring for recurrence of prostatic carcinomas. Finally, the more basic implications of endocrine-paracrine cells and neuroendocrine differentiation are speculated on in reference to prostatic carcinogenesis and autocrine/paracrine tumor growth factor activity.

Neuroendocrine differentiation in prostatic malignancy

The prostatic neuroendocrine cell is a regulatory cell that produces serotonin and peptide hormones. This cell is part of a more widely dispersed diffuse neuroendocrine regulatory system known as the APUD system. Focal neuroendocrine differentiation is seen in virtually all prostate carcinomas to one degree or another. Specific malignancies that are purely neuroendocrine include small cell carcinoma and carcinoid/carcinoid‐like tumors. A variety of studies suggest a possible prognostic significance of neuroendocrine differentiation in prostate carcinoma.

Small cell carcinoma of the prostate: An immunohistochemical study

Small cell carcinoma of the prostate (SCPC) is morphologically similar to small cell carcinoma of the lung (SCLC) and maybe misinterpreted as Gleason pattern 5b prostate adenocarcinoma (HGPC). Recognition of SCPC is important because of its different clinical behavior. This study aims to characterize the immunophenotype of histologically classic SCPC using a comprehensive panel of markers, to better understand its histogenesis, aid in its classification, and evaluate potential therapeutic targets. Using the World Health Organization morphologic criteria for SCLC, 18 SCPC cases were identified; and studied for the following tumor marker groups: prostate specific/related, neuroendocrine, sex steroid hormone receptors, and prognostic/treatment target-related. Ten cases of UPC were used as controls. PSA was positive in 17% of SCPC and neuroendocrine markers were expressed in HGPC. PSA, TTF-1 and CD56 were the most helpful markers in differentiating between SCPC and HGPC (P<0.01), whereas bombesin/GRP, c-kit, bcl-2, and EGFR expression was more frequent in SCPC. SCPC is best diagnosed by following the World Health Organization diagnostic criteria for SCLC. Immunohistochemical markers can help separate SCPC from HGPC and may be useful in histologically borderline cases. Potential therapeutic targets are identified immunohistochemically in SCPC (Bombesin/GRP, c-kit, bcl-2, and EGFR).

Staging of early prostate cancer: A proposed tumor volume-based prognostic index

Current staging of early prostate cancer separates patients into two groups: those with palpable and non-palpable tumors. Such staging relies on digital rectal examination in making this separation, despite the low sensitivity, low specificity, and low positive predictive value of this method. As an alternative, tumor volume may be useful for staging because of its powerful prognostic ability and its potential to be assessed clinically due to recent advances in imaging techniques such as transrectal ultrasound. In this study, we evaluate the utility of tumor volume in predicting progression of early prostate cancer based on the composite published evidence from nine pathologic studies of serially-sectioned prostates. Logistic regression revealed that tumor volume was a good positive predictor of all measures of tumor progression. There was a 10 percent probability of capsular invasion in tumors measuring about 0.5 cm3; 10 percent probability of seminal vesicle invasion in tumors measuring about 4.0 cm3; and 10 percent probability of metastases in tumors measuring about 5.0 cm3. These composite results suggest that tumor volume is a significant predictor of cancer progression. A volume-based prognostic index is proposed as an adjunct to staging for early prostate cancer.

Neuroendocrine differentiation in prostatic carcinoma

Specimens from 53 cases of prostatic carcinoma obtained during total prostatectomy or transurethral resection of prostate were analyzed for neurendocrine differentiation with immunocytochemical tests for serotonin, neuron-specific enolase, and chromogranin as well as with the Churukian-Schenk argyrophil reaction. Forty-seven per cent (25 of 53) of the prostatic carcinomas were positive for neuroendocrine differentiation, usually with an overlapping combination of these techniques. Nine per cent (five cases) contained areas with numerous neuroendocrine cells, 11 per cent (six cases) had focal scattered neuroendocrine cells, and 26 per cent (14 cases) had rare neuroendocrine cells. The positive cases spanned the histologic spectrum of prostatic adenocarcinoma; histologically none resembled a carcinoid tumor or a small cell carcinoma. Positive cases were further studied with a battery of antisera to 12 polypeptide hormones. Immunoreactivity to only bombesin (one case) and calcitonin (two cases) was detected. In five cases, neuroendocrine differentiation was studied by electron microscopy and verified at the ultrastructural level.

Toxicity of cadmium in the perfused human placenta

Cadmium, a placental toxicant in rodents, was studied in the in vitro isolated dually perfused human placental lobule for periods of up to 12 hr to determine if cadmium can also be toxic in the human placenta. Placental lobules were perfused with a modified M199 medium containing 0, 10, 20, or 100 nmol of cadmium chloride/ml added only initially to the maternal perfusate. Every 4 hr, the perfusates in both the maternal and the fetal circuits were replaced with fresh perfusate containing no Cd. Measurements during perfusion were oxygen consumption, net fetal oxygen transfer, fetal pressure, fetal volume loss, glucose utilization, lactate production, human chorionic gonadotropin (hCG), and zinc transfer. Postperfusion, morphology, and tissue slice studies were performed to evaluate cellular metabolic function and uptake of an amino acid (alpha-[14C]-aminoisobutyric acid). In all cadmium experiments, there were no significant alterations in oxygen consumption, lactate production, glucose utilization, or amino acid uptake compared with controls; however, there were dose-related changes in the synthesis and release of the protein hormone, hCG, beginning within 4 hr of initial exposure to Cd. There were also dose-related volume loss from the fetal vasculature (greater than 6 ml/hr) and ultrastructural changes (subsyncytiotrophoblastic vesiculations, stromal edema, vacuoles in Hofbauer cells), with necrosis at 100 nmol Cd/ml occurring between 5 and 8 hr. Cadmium (10 nmol/ml) reduced the placental transfer of zinc into the fetal circuit. Thus, the human placenta is a site for toxic action of cadmium and is at least as sensitive as the rodent placenta to the actions of cadmium. In addition, these human studies demonstrated a selectivity in the toxic effects with a maintenance of carbohydrate metabolism and amino acid uptake even after 12 hr of exposure with placental Cd burdens of 151 +/- 37 nmol/g, but with the earliest (within 4 hr) dose-related functional alterations occurring in protein hormone production and zinc transfer followed by later changes in morphology with a tissue Cd burden of 46.5 +/- 4.0 nmol/g.

Neuroendocrine differentiation in prostatic carcinoma: an update.

BACKGROUND Neuroendocrine differentiation in prostatic carcinoma may be related to the growth and prognosis of prostate cancer, especially androgen-insensitive tumors. MATERIALS AND METHODS. This update reviews new investigations relating to neuroendocrine differentiation of prostatic carcinoma building on two previous review articles. All relevant publications are systematically reviewed. RESULTS New developments include the detection of bombesin, calcitonin and serotonin receptors, as well as a clearer delineation of the role that neuroendocrine products play in the growth, invasiveness, and motility of prostate cancer. Prognostic studies are still somewhat contradictory, but those studies and studies related to serum/plasma levels of neuroendocrine products in prostate cancer suggest that neuroendocrine differentiation may be more important in androgen-independent tumors and metastatic tumors than in hormone-sensitive and locally recurrent tumors. New cell line xenograft and transgenic mouse models for neuroendocrine prostatic carcinoma are described and will provide the basis for further investigations into the role played by neuroendocrine differentiation in prostatic carcinoma. CONCLUSIONS Neuroendocrine differentiation in prostatic carcinoma is of great potential significance but needs to be better defined before its significance can be accurately assessed. Prostate Supplement 8:74–79, 1998.

Parathyroid hormone-related protein is expressed by prostatic neuroendocrine cells☆

OBJECTIVE Parathyroid hormone-related protein (PTHrP) is a regulatory peptide that has been associated with normal fetal growth and differentiation as well as the regulation of fetal calcium. In a variety of cancers, PTHrP has been implicated in the humoral hypercalcemia of malignancy. Recently, we demonstrated that all prostatic adenocarcinomas express PTHrP. In the present study, the localization of PTHrP and its mRNA in nonmalignant prostate tissue was assessed. METHODS Formalin-fixed, paraffin-embedded prostatic tissues from 23 patients were evaluated. Immunocytochemistry (ICC) was performed by the streptavidin-peroxidase enzyme conjugate method using a monoclonal antibody, 8B12, generated against fragment 1-34 of the amino-terminal end of PTHrP. Nonradioactive in situ hybridization was carried out using a digoxigenin labeled single-stranded cDNA probe complementary to the sequence coding for PTHrP(15-120). RESULTS PTHrP immunoreactivity was observed in the cytosol of a few epithelial cells. Double labeling and serial section ICC with 8B12 and a monoclonal antibody to chromogranin A (a generic neuroendocrine [NE] marker) revealed that PTHrP was present in a subpopulation of prostatic NE cells. In situ hybridization of mirror image sections demonstrated positive signals in prostatic NE cells in complete accordance with the ICC findings. CONCLUSIONS The localization and production of PTHrP in prostatic NE cells suggest that this polypeptide may act in an endocrine-paracrine fashion involved in the prostatic growth and differentiation as well as the regulation of calcium in semen and seminal fluid.

Differential Expression of Interleukin-8 and Its Receptors in the Neuroendocrine and Non-Neuroendocrine Compartments of Prostate Cancer

Hormonal therapy (androgen ablation and/or inhibition of androgen action) is the treatment of choice for advanced prostate cancer. After an initial response in most patients, tumors invariably progress to an androgen-independent state. It is unclear how prostate cancer cells proliferate without androgen. Recent studies suggest that interleukin-8 may promote androgen-independent proliferation, but the source of interleukin-8 in the prostate is unknown. Using immunohistochemistry, we show that interleukin-8 was expressed by the neuroendocrine tumor cells in human prostate cancer tissue. Expression of the interleukin-8 receptor CXCR1 was negative or low in benign prostatic tissue and was frequently increased in malignant cells of high-grade prostatic intraepithelial neoplasia and prostate cancer; however, CXCR1 was not detected in the neuroendocrine tumor cells, suggesting a paracrine mechanism by which interleukin-8 produced by neuroendocrine tumor cells stimulates androgen-independent proliferation of prostate cancer. Neuroendocrine tumor cells expressed another type of interleukin-8 receptor, CXCR2, suggesting an autocrine mechanism by which interleukin-8 regulates the differentiation or function of the neuroendocrine cells. These results, combined with previous reports that neuroendocrine differentiation is induced by hormonal therapy, suggest that neuroendocrine cells play an important role in promoting androgen-independent growth of prostate cancer through interleukin-8 signaling.