Liang Cheng, Professor and Vice Chair at The Warren Alpert Medical School of Brown University, shared on LinkedIn:
“Happy Friday! I am delighted to share our work Dr. Anandi Lobo-Kapoor published in Endocrine Pathology EndoPath (Journal Impact Factor: 14.7) PMID: 40699451
Full article is available here.
Summary:
Neuroendocrine tumors (NETs) of the prostate represent a distinct subset of prostate cancer characterized by neuroendocrine differentiation, unique clinical behavior, and significant diagnostic and therapeutic challenges. Despite their clinical importance, consensus is lacking regarding optimal classification, diagnostic criteria, immunohistochemical evaluation, and management strategies. The 2022 WHO classification for genitourinary neuroendocrine neoplasms provides a general framework, but the considerable biological and clinical heterogeneity of prostate NETs highlights the need for an organ-specific system. A refined classification that integrates histomorphology with clinical and molecular features would better reflect disease diversity and guide patient care.
Recent advances in molecular profiling, imaging, and targeted therapies have transformed understanding of neuroendocrine prostate cancer (NEPC). Genomic and transcriptomic studies have revealed key pathways underlying disease progression, enabling discovery of novel biomarkers and actionable therapeutic targets. Liquid biopsy and molecular assays now allow real-time detection of progression and treatment resistance, advancing precision oncology for these aggressive tumors.
Imaging innovations, particularly in nuclear medicine, are central to this progress. While [¹⁸F]FDG PET has demonstrated utility in detecting advanced NEPC – especially in cases with low or absent PSMA expression – it lacks specificity, underscoring the need for more selective radiopharmaceuticals. Theranostic approaches combining molecular imaging with targeted therapy represent an emerging frontier.
Collectively, these advances support a shift away from purely morphology-based classification toward a molecularly informed framework that incorporates biomarkers predictive of prognosis and therapeutic response. Future efforts should focus on validating molecular markers, refining diagnostic criteria, and conducting prospective trials of novel therapies. Establishing an integrated diagnostic system that combines morphological, molecular, and clinical parameters will be essential to improve prognostication, enable tailored therapy, and ultimately enhance survival outcomes for patients with prostate NET.”
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