Program Operations Manual System (POMS)
TN 36 (09-20)
DI 23022.310 Small Cell Cancer of the Prostate
COMPASSIONATE ALLOWANCES INFORMATION
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SMALL CELL (OAT CELL) CANCER OF THE
PROSTATE
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ALTERNATE NAMES
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Cancer of the Prostate Gland; Prostatic Cancer; Prostatic Carcinoma; Small Cell Carcinoma
(SCC) of the Prostate
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DESCRIPTION
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Small Cell Cancer of the Prostate is a rare cancer occurring less than 1% of all cancers of the prostate. They are
aggressive tumors that often present at advanced stages or as metastatic diseases
and are occasionally associated with paraneoplastic syndromes. Some small cell carcinomas
represent recurrent tumors after hormonal therapy for conventional adenocarcinomas
of the prostate. More commonly, small cell carcinoma is present as a component of
mixed tumors, which also contain a component of conventional adenocarcinoma. Small
cell carcinomas of the prostate are similar to the more common small cell carcinomas
of the lung.
They are characterized by the following features:
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Solid, sheet-like growth pattern, often with areas of tumor necrosis;
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Small, round to spindle cells with scant cytoplasm, high nuclear/cytoplasmic ration
and ill-defined borders;
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Hyperchromatic nuclei with finely granular chromatin and nuclear molding;
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Absent or inconspicuous nucleoli; and
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Small cell carcinomas are often positive for NE markers chromogranin-A, synaptophysin
and NSE although one or more of these markers may be negative in any given case. Like
small cell carcinomas of the lung, tumor cells often show dot-like cytokeratin staining
pattern and are often positive for TTF-1. In contrast to prostatic adenocarcinoma,
tumor cells of small cell carcinoma are usually negative for androgen receptor and
PSA but exceptions exist.
Physical
findings: Small Cell Carcinoma of the Prostate presents as a solid growth pattern, which makes
it difficult to separate from adenocarcinomas, however, immunohistochemical study
can help in diagnosing this condition.
ICD-9: 185.0
ICD-10:
C61
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PROGRESSION
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The progression of small cell carcinoma of the prostate is usually rapid and fatal. |
TREATMENT
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Hormonal therapy is not effective in treating small cell carcinoma of the prostate
and neither is surgery. The general response to chemotherapy, the main form of therapy
for small cell carcinoma, is some initial response but progressing to a rather rapid
downhill course.
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SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for
Evaluation:
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A pathology report of a biopsy specimen from the prostate showing small cell histology.
There is no substitute for pathology.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
13.24 C |
Requires only pathology for adjudication. |
Equals |
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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