Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.310 Small Cell Cancer of the Prostate
COMPASSIONATE ALLOWANCE INFORMATION
SMALL CELL CANCER OF THE PROSTATE
Small Cell Cancer (carcinoma) of the Prostate is a rare cancer occurring in no more than 1 percent of all cancers of the prostate. They are aggressive tumors which 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: 1) solid, sheet-like growth pattern, often with areas of tumor necrosis; 2) small, round to spindle cells with scant cytoplasm, high nuclear/cytoplasmic ration and ill-defined borders; 3) hyperchromatic nuclei with finely granular chromatin and nuclear molding; 4) absent or inconspicuous nucleoli, and 5) high mitotic rate.
Cancer of the Prostate Gland, Prostatic Cancer, Prostatic Carcinoma, Small Cell Carcinoma of the Prostate
DIAGNOSTIC TESTING AND CODING
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. 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.
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.
The progression of small cell carcinoma of the prostate is usually rapid and fatal.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report of a biopsy specimen from the prostate showing small cell histology. There is no substitute for pathology.
Suggested Listings for Evaluation:
Small cell carcinoma of the prostate gland equals this listing with a diagnosis confirmed by a biopsy.
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.