Small Cell Prostate Cancer; Center Review of Two Cases and Testimony of a Rare and Aggressive Disease

Small cell cancers were initially described in the lungs and later found to occur in a wide range of organs of the body, constituted a disease entity that is characterized by an aggrieve path/course and a huge disease related mortality. They are also called neuroendocrine tumors with peculiar histologic and biologic disease entity. Here we present two cases of small cell cancer of the prostate seen and managed in our facility with focus on their presentation, disease progression and outcome. The first patient was a 72-year-old retired military officer who presented with a progressively painful scrotal swelling of 3-month duration, and scrotal ulceration with contact bleeding of a month duration associated with a foul-smelling discharge. There was also history of progressive weight lost, loss of appetite and constipation. Patient was pale and lethargic on examination with a foul smelling exophytic scrotal mass. Serum PSA was 4 ng/l (within normal limit). Wedge biopsy and trucut prostate biopsy revealed small cell cancer of the prostate. Patient was resuscitated and prepared for chemoradiation, had a single dose of chemotherapy and died before the second dose. Second patient was a 63-year-old farmer who presented with lower urinary tract symptoms, progressive weight loss and constipation of two months duration, a known hypertensive and diabetic who has been regular on his medication. He was lethargic on examination, pale and unable to stand without support. Trucut prostate biopsy shows small cell cancer of the prostate. He was also resuscitated and being prepared for chemoradiation but died before commencement of treatment.