Department of Internal Medicine, Division of Medical Oncology , University of Colorado, Aurora, Colorado, USA.
Divisions of Human Biology and Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Prostate. 2023 May;83(7):641-648. doi: 10.1002/pros.24497. Epub 2023 Feb 13.
Amphicrine prostate carcinoma (AMPC) is a poorly defined subset of prostate cancer in which cells co-express luminal prostate epithelial and neuroendocrine markers. The optimal treatment strategy is unknown. We sought to further characterize the clinical, histomorphologic, and molecular characteristics of AMPC and to identify areas of potential future treatment investigations.
We retrospectively identified 17 cases of AMPC at a single institution, defined as synaptophysin expression in >70% of cells and co-expression of androgen receptor (AR) signaling markers (either AR, PSA, or NKX3.1) in >50% of cells. Clinical and histologic features of AMPC cases as well as response to treatment and clinical outcomes were described.
Five AMPC cases arose de novo in the absence of prior systemic treatment and behaved distinctly from cases that were treatment-emergent. In these de novo cases, despite expression of neuroendocrine markers, prognosis appeared more favorable than high-grade neuroendocrine carcinoma, with two (40%) patients with de novo metastatic disease, universal response to androgen deprivation therapy, and no deaths at a median follow-up of 12.3 months. Treatment-emergent AMPC arose a median of 41.1 months after androgen deprivation therapy initiation and was associated with poor response to therapy.
We show that amphicrine prostate cancer is a unique entity and differs in clinical and molecular features from high-grade neuroendocrine carcinomas of the prostate. Our study highlights the need to recognize AMPC as a unique molecularly defined subgroup of prostate cancer.
两性细胞前列腺癌（AMPC）是前列腺癌的一个定义不明确的亚类，其中细胞共同表达腔前列腺上皮和神经内分泌标志物。最佳治疗策略尚不清楚。我们试图进一步描述 AMPC 的临床、组织形态学和分子特征，并确定未来治疗研究的潜在领域。
我们在一家机构中回顾性地确定了 17 例 AMPC 病例，定义为突触素在>70%的细胞中表达，雄激素受体（AR）信号标志物（AR、PSA 或 NKX3.1）在>50%的细胞中共同表达。描述了 AMPC 病例的临床和组织学特征以及对治疗的反应和临床结果。
5 例 AMPC 是在没有先前系统治疗的情况下新出现的，与治疗后出现的病例明显不同。在这些新发病例中，尽管表达神经内分泌标志物，但预后似乎比高级别神经内分泌癌更有利，有 2 例（40%）新发转移性疾病患者，对雄激素剥夺治疗普遍有反应，且在中位随访 12.3 个月时无死亡。治疗后出现的 AMPC 在雄激素剥夺治疗开始后中位数为 41.1 个月出现，与治疗反应差相关。
我们表明两性细胞前列腺癌是一种独特的实体，在临床和分子特征上与前列腺的高级别神经内分泌癌不同。我们的研究强调需要将 AMPC 识别为前列腺癌的一个独特的分子定义亚组。
