THE PROGNOSTIC VALUE OF NEUROENDOCRINE DIFFERENTIATION IN ADENOCARCINOMA OF THE PROSTATE IN RELATION TO PROGRESSION OF DISEASE AFTER ENDOCRINE THERAPY

Purpose: We evaluated the prognostic impact of neuroendocrine differen tiation in prostate cancer with regard to the onset of endocrine thera py failure. Materials and Methods: A retrospective study was performed on 72 transurethral resection specimens from patients who subsequentl y underwent endocrine therapy for prostate cancer and were followed fo r 44 to 95 months. Progression-free interval was recorded. Distributio n pattern and proportion of neuroendocrine cells were examined in tran surethral resection specimens. Neuroendocrine cells were identified ba sed on immunoreactivity for chromogranin A. Results: Of 32 patients wi th progressive disease 27 died of prostate cancer. Chromogranin A posi tive cells were found in 40 of the 72 prostate cancers (55%). In a Cox proportional hazards analysis neuroendocrine differentiation of the t umor showed a negative correlation with progression-free survival (p = 0.022), which proved to be independent of the Gleason score (p <0.001 ). Conclusions: Our results support the view that neuroendocrine diffe rentiation in prostatic adenocarcinomas is a prognostic factor for pro gressive disease under subsequent endocrine therapy. This prognosticat or acts independently of tumor grade.