Introduction and Objective:
Primary prostatic signet ring cell cancer (SRCC) is rare and aggressive type of prostatic malignancy. In documented epidemiological studies it represents 30 per 100,000 cases of prostatic malignancy. It is a highly malignant and aggressive form of prostate cancer associated with a poor prognosis with just over 150 cases have been reported in the literature to date. The objective of this research was to review the current literature on prostatic SRCC and summaries the clinical manifestation, diagnosis and management of this rare pathology.
Methods and Materials:
This review was performed across three databases including Pubmed, Medline and Embase. The following search terms were used; “prostate cancer” AND “signet ring cell cancer”. A language restriction to English papers was applied and no date limit was applied. Fifty-seven articles with over seventy cases were reviewed.
Results:
Primary prostatic SRCC is a rare pathology occurring in 0.02% of prostate carcinomas. Across the papers it was documented to be more aggressive with diagnosis at late stage of disease and have a poor prognosis with a five-year survival rate of 11.7%. Clinically, primary prostatic SRCC presents similar to other poorly differentiated prostate cancers. They were often identified in cases of asymptomatic individuals with raising levels of PSA. As per the World Health Organisation (WHO) at least 25% of the whole tumour must consist of signet ring cell morphology. Immunohistochemical examination of prostatic SRCC usually shows a positive expression of PSA and PAP, while negative CEA. Currently, there is no standard guideline for managing primary prostatic SRCC and most treatment regimens are similar to the traditional management of prostatic adenocarcinoma. Given the aggressive nature of primary prostatic SRCC, multimodal treatment should be considered over a single treatment modality. Majority of papers showed an increased survival rates with multimodal treatment.
Conclusion:
Primary prostatic SRCC is a rare, aggressive malignant tumour with rapid disease progression and poor prognosis. There is no clear management strategy for this form of prostate cancer; however, multimodal treatment is recommended. With the further identification of SRCC of the prostate, systematic reviews should be performed to assess improved treatment strategies.