Clinical features of "anaplastic" or aggressive-variant castration-resistant prostate cancer

Castration-resistant* prostate carcinoma with at least 1 of the following:	n (%)
C1. Histologic evidence of small cell prostate carcinoma (pure or mixed).	29 (25.4)
C2. Exclusively visceral metastases.	19 (16.7)
C3. Radiographically predominant lytic bone metastases by plain radiograph or CT scan.	16 (14.0)
C4. Bulky (≥5 cm) lymphadenopathy OR bulky (≥5 cm) high-grade (Gleason ≥8) tumor mass in the prostate/pelvis.	49 (43.0)
C5. Low PSA (≤10 ng/mL) at initial presentation (prior to ADT or at symptomatic progression in the castrate setting) PLUS high-volume (≥20) bone metastases.	26 (22.8)
C6. Presence of neuroendocrine markers on histology (positive staining of chromogranin A or synaptophysin) OR in serum (abnormal high serum levels for chromogranin A or GRP) at initial diagnosis or at progression. PLUS any of the following in the absence of other causes: Elevated serum LDH (≥2 × IULN) Malignant hypercalcemia Elevated serum CEA (≥2 × IULN)	21 (18.4)
C7. Short interval (≤6 months) to androgen-independent progression following the initiation of hormonal therapy, with or without the presence of neuroendocrine markers.	52 (45.6)

CT: computed tomography; PSA: prostate-specific antigen; ADT: androgen deprivation therapy; GRP: gastrin-releasing peptide; LDH: lactic acid dehydrogenase; IULN: institutional upper limit of normal; CEA: carcinoembryonic antigen.
* Patients with small cell prostate carcinoma on histologic evaluation were not required to have castration-resistant disease.

Reprinted from Clinical Cancer Research, Copyright © 2013, Volume 19, Issue 13, pp. 3621-3630, Aparicio AM, Harzstark AL, Corn PG, et al, Platinum-based chemotherapy for variant castrate-resistant prostate cancer, with permission from AACR.

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Clinical features of "anaplastic" or aggressive-variant castration-resistant prostate cancer