MP68-19 CHARACTERISTICS AND OUTCOMES OF PRIMARY NEUROENDOCRINE/SMALL CELL PROSTATE CANCER OCCURRING IN THE VETERAN AFFAIRS (VA) POPULATION

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP68)1 May 2024MP68-19 CHARACTERISTICS AND OUTCOMES OF PRIMARY NEUROENDOCRINE/SMALL CELL PROSTATE CANCER OCCURRING IN THE VETERAN AFFAIRS (VA) POPULATION Chelsea K. N. Nwonwu, Ruben Raychaudhuri, Anata Wadhu, Ashley-Marie Y. Green-Lott, Lorna Kwan, Candace L. Haroldsen, Atim Effiong, Jeremy B. Shelton, Beatrice S. Knudsen, Mattew B. Rettig, Nicholas G. Nickols, Kara N. Maxwell, Robert B. Montgomery, and Isla P. Garraway Chelsea K. N. NwonwuChelsea K. N. Nwonwu , Ruben RaychaudhuriRuben Raychaudhuri , Anata WadhuAnata Wadhu , Ashley-Marie Y. Green-LottAshley-Marie Y. Green-Lott , Lorna KwanLorna Kwan , Candace L. HaroldsenCandace L. Haroldsen , Atim EffiongAtim Effiong , Jeremy B. SheltonJeremy B. Shelton , Beatrice S. KnudsenBeatrice S. Knudsen , Mattew B. RettigMattew B. Rettig , Nicholas G. NickolsNicholas G. Nickols , Kara N. MaxwellKara N. Maxwell , Robert B. MontgomeryRobert B. Montgomery , and Isla P. GarrawayIsla P. Garraway View All Author Informationhttps://doi.org/10.1097/01.JU.0001008744.60568.e8.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Primary neuroendocrine/small cell prostate carcinoma (NEPC) is extremely rare, but highly lethal. Understanding the molecular and biological underpinnings of this pathologic subtype could inform management approaches that may be relevant to metastatic castration-resistant prostate cancer (mCRPC) where a similar phenotype is often observed. In this population-based study performed across the diverse, nationwide Veterans Affairs (VA) Health Administration, we describe patient characteristics, disease presentation, pathological features, and clinical outcomes associated with primary NEPC. METHODS: This institutional review board-approved retrospective case-control cohort study included 210 primary NEPC cases and 828 grade group 5 (GG5) controls matched on age at prostate cancer diagnosis, year of diagnosis, self-identified race/ethnicity, and Charleson co-morbidity index from a database of approximately 214,416 prostate pathology reports associated with surgical specimens collected as part of routine care in VA healthcare centers between 1999-2022. Manual chart review, as well as abstraction of structured data elements from VA data databases accessed through the VA Informatics and Computing Infrastructure (VINCI) permitted creation of the final case-matched analytic cohort. RESULTS: Veterans with NEPC exhibited lower PSA values at diagnosis (p<0.01) but higher median PSA nadirs following treatment than case-matched GG5 controls (0.45 (IQR 0.10-2.28) vs 0.12 (IQR 0.07-1.45), p<0.01). These cases also had a higher rate of de novo metastases (68% vs 29%, p<0.01) and were more likely to be treated with docetaxel and/or platinum chemotherapy in addition to ADT (14% vs 5%, and 30% vs 2%, respectively, both p<0.01). Finally, primary NEPC cases displayed higher mortality (70% vs. 23%, p<0.01) with a shorter median (IQR) survival of 3.1 years (2.1, 4.0) vs 7.8 years (6.7, 8.4) for controls (p<0.01). No differences were observed in body mass index, tobacco use, history of self-reported Agent Orange exposure, or the neighborhood area deprivation index (ADI) quintile at the time of PCa diagnosis. CONCLUSIONS: In one of the largest series of primary NEPC cases to date, this pathologic variant is rare in the VA population and associated with significantly worse outcomes compared to case-matched GG5 controls. Source of Funding: Research support for the investigators include National Institutes of Health (K08CA215312, KNM; 5P50CA092131, R01 PAR-20-077, IPG); US Department of Defense (W81XWH211075, IPG; W81XWH-19-1-0435, KY); Prostate Cancer Foundation (PCF22CHAL02, IPG; PCF17CHAL04, IPG; 20YOUNG02, KNM; 18VALO10, KY, NGN, PCF21CHAL02), Burroughs Wellcome Foundation (1017184, KNM); Basser Center for BRCA at the University of Pennsylvania (KNM); Jean Perkins Foundation (IPG), STOP Cancer Foundation (IPG), and VA ORD CSR&D (NGN), DOD W81XWH2210030 (CR), Prostate Cancer Research, UK (HSI, TRR); Association of VA Surgeons Resident Research Award 85478 (AYG) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1116 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Chelsea K. N. Nwonwu More articles by this author Ruben Raychaudhuri More articles by this author Anata Wadhu More articles by this author Ashley-Marie Y. Green-Lott More articles by this author Lorna Kwan More articles by this author Candace L. Haroldsen More articles by this author Atim Effiong More articles by this author Jeremy B. Shelton More articles by this author Beatrice S. Knudsen More articles by this author Mattew B. Rettig More articles by this author Nicholas G. Nickols More articles by this author Kara N. Maxwell More articles by this author Robert B. Montgomery More articles by this author Isla P. Garraway More articles by this author Expand All Advertisement PDF downloadLoading ...