Neuroendocrine differentiation in prostatic carcinoma

Knowledge and understanding of the pathophysiology of prostate cancer remain rudimentary. However, insight into epigenetic events and cellular interactions between cancer cells and the surrounding milieu has recently opened up a broader concept of cancer development. Throughout the entire process of prostate cancer aetiology, progression and metastasis, the microenvironment of the local host tissue is an active participant, and the selective pressure exercised on the malignant cells changes with the tumour-host setting. Thus primary cancers and metastases may respond differently to biomolecules and treatment modalities. Indeed, treatment itself changes the selective pressure, and new cellular capabilities may evolve. In prostate cancer, neuroendocrine differentiation is believed to occur in response to androgen ablation, and neuroendocrine paracrine factors have been shown to stimulate growth of androgen-independent cancer cells. Review of the accumulated knowledge in this field suggests that we need to improve our understanding of neuroendocrine cells and their regulatory products and their influence in the prostate gland. Recent research shows promise however, and no doubt new protocols will soon emerge in the treatment of prostate cancer, based on neuroendocrine hormones and their intracellular pathways.