Aparicio Ana, Tzelepi Vassiliki
Oncology (Williston Park). 2014 Oct 15;28(10):831-8.
Atypical clinical features in men with prostate cancer-such as clinical evidence of disease progression in the absence of a proportional increase in serum prostate-specific antigen level, bulky symptomatic tumor masses, exclusive visceral metastases, or a predominance of lytic bone metastases-should alert the clinician that an aggressive prostate cancer variant is present or emerging. Aggressive variants of prostate cancer often take the form of neuroendocrine or small-cell carcinomas, which frequently lack androgen receptor expression and respond poorly to hormonal therapies. Indeed, the finding of neuroendocrine or small-cell prostate carcinoma indicates the need for multimodality treatments that incorporate early combination chemotherapy and locoregional control of bulky tumor deposits, including untreated or recurrent primaries. As we learn to recognize this prostate cancer variant more often, we are reminded that not all prostate cancers share the same biology and that the androgen receptor is not the sole driver of this disease.
前列腺癌男性患者的非典型临床特征，如在血清前列腺特异性抗原水平未相应升高的情况下出现疾病进展的临床证据、体积较大的有症状肿瘤肿块、单纯的内脏转移或溶骨性骨转移占优势等，应提醒临床医生存在或正在出现侵袭性前列腺癌变体。侵袭性前列腺癌变体通常表现为神经内分泌癌或小细胞癌，这些癌症往往缺乏雄激素受体表达，对激素治疗反应不佳。事实上，发现神经内分泌或小细胞前列腺癌表明需要采用多模式治疗，包括早期联合化疗以及对体积较大的肿瘤沉积物进行局部区域控制，包括未治疗或复发的原发灶。随着我们越来越频繁地识别这种前列腺癌变体，我们被提醒并非所有前列腺癌都具有相同的生物学特性，并且雄激素受体并非这种疾病的唯一驱动因素。
