Epidemiology and Overall Survival of De Novo and Transformed Neuroendocrine Prostate Cancer: A Two-Nation Population-Based Study of 1,465 Patients from the United States and England

Why clinicians should know about it

• Picked for Urology (paper of the day, 12 August 2026): Population study of neuroendocrine prostate cancer survival

Abstract

BACKGROUND: Neuroendocrine prostate cancer (NEPC) is a rare and aggressive variant of prostate cancer (PC) that can be de-novo (d-NEPC) or transform from prior prostate adenocarcinoma (PCa) as treatment-emergent NEPC (t-NEPC). This study aimed to study the clinical characteristics and overall survival (OS) of NEPC using data from the SEER and NCRAS registries, and to compare their OS. METHODS: A total of 1,465 patients with NEPC were extracted from SEER (N=990, 2010-2022) and NCRAS (N=475, 2010-2021). Patients were classified as t-NEPC if preceded by a documented PCa. The primary outcome is OS measured from the date of NEPC diagnosis. Kaplan-Meier analysis, log-rank test, and Cox regression were performed for SEER, NCRAS, and pooled cohorts. RESULTS: t-NEPC represented 9.9% in NCRAS and 15.2% in SEER. Small cell carcinoma was the most common subtype (80.2% NCRAS, 74.7% SEER). Median time to transformation was 4.63 years in NCRAS and 5.0 years in SEER. In the pooled cohort, median OS was 9 months for d-NEPC and 7 months for t-NEPC (log-rank p<0.001). The 60-month OS was 7.9% for d-NEPC and 4.0% for t-NEPC. In the pooled multivariable Cox regression, t-NEPC was independently associated with worse OS (aHR 1.30, 95% CI 1.11-1.53, p=0.001). Data source was not associated with OS (aHR 1.08, p=0.206), indicating comparable OS between the USA and England. CONCLUSION: In this bi-national, population-based study, t-NEPC was associated with worse OS than d-NEPC. OS for NEPC was comparable between the USA and England. These findings support distinguishing d-NEPC from t-NEPC.

Abstract as published, via PubMed.