Although prostate cancer is a common cancer in men, there are
different types of prostate cancer, and some of these are rare.
Because they are rare, we don’t know so much about them. If you are
diagnosed with one of the cancers mentioned here, speak to your
doctor or nurse about what that means and what treatments are
suitable for you.
Like all the organs in our body, the prostate is made up of
different types of cells. The type of cancer that develops
depends on the type of cell where it starts.
The most common kind of prostate cancer starts in some of the
cells that line the prostate – called glandular epithelial cells.
When we talk about typical prostate cancer here, we mean this
common type of prostate cancer. You may hear it called
adenocarcinoma, or sometimes acinar adenocarcinoma. You might see
this written in your pathology report.
Some much rarer types of cancer can also develop from glandular
epithelial cells in the prostate. And there are other types of
prostate cancer which develop from different cells in the prostate.
For example, small cell prostate cancer
develops from cells called neuroendocrine cells, so it’s a
neuroendocrine prostate cancer. These other types of prostate
cancer are also rare.
Some men have more than one type of prostate cancer. For
example, they have some typical prostate cancer as well as a rare
Some of these rare cancers may be more aggressive than typical
prostate cancer. This means they may grow faster and are more
likely to spread outside the prostate.
Some of the tests used to diagnose prostate cancer may not be as
good at picking up rare prostate cancers. Because of this, some
rare cancers may not be diagnosed until after they have spread
outside of the prostate. For example, some – such as small cell
prostate cancer – don’t cause your PSA level to rise, so
they’re not always picked up by a PSA test.
These different types of prostate cancer look different under a
microscope, so may be picked up after having a biopsy to check for
prostate cancer, or a transurethral resection of the prostate (TURP) to treat an enlarged prostate.
But rare cancers are not always given a Gleason score after a biopsy. This
is because they can behave differently from typical prostate cancer
and can’t be measured in the same way.
Because rare cancer can be aggressive and spread outside the
prostate, you may have more tests, such as a CT scan or MRI scan, to check whether it has spread.
There are several kinds of rare cancers that can develop in the
Small cell prostate
Small cell prostate cancer develops from cells in the prostate
called neuroendocrine cells. You may hear it called a
neuroendocrine prostate cancer.
Neuroendocrine cells do not produce PSA, so a PSA test won’t help
to diagnose small cell prostate cancer. And PSA tests won’t be used
to monitor it, either.
Small cell prostate cancer may be aggressive. It may be treated
Large cell prostate
There’s also another type of neuroendocrine prostate cancer
called large cell prostate cancer. Like small cell prostate cancer,
it develops from neuroendocrine cells in the prostate. Large cell
prostate cancer is very rare and we don’t know very much about
Like typical prostate cancer, some rare prostate cancers can
develop from gland cells in the lining of the prostate. You may
hear them called adenocarcinomas. Ductal prostate cancer, mucinous
prostate cancer and signet ring cell prostate cancer are all
Ductal prostate cancer
You may also hear this called ductal adenocarcinoma.
Ductal prostate cancer may grow close to the urethra. It can
cause peeing problems and blood in your urine. And it might be more
aggressive than typical prostate cancer.
You may also hear this called mucinous adenocarcinoma.
Like typical prostate cancer, mucinous prostate cancer can cause
the levels of PSA in the blood to rise.
There’s a lot we don’t know about mucinous prostate cancer. Some
studies suggest it’s aggressive and doesn’t respond well to
treatments for typical prostate cancer. But more recent research
shows it might not be as aggressive as once thought.
ring cell prostate cancer
You might also hear this called signet cell prostate cancer.
Most signet ring cell cancers in the prostate are secondary
cancers – they have developed in another part of the body such as
the bladder or stomach and then spread to the prostate. For
example, a signet ring cell cancer that started in the stomach is
stomach cancer, even if it has spread to the prostate. But if the
cancer started in the prostate, it’s prostate cancer.
If your biopsy shows that you have signet ring cell cancer, you
may need to have further tests to check whether it started in your
prostate or somewhere else. If your cancer started in another part
of the body, this could affect what kind of treatment you have. For
example, if the cancer spread to the prostate from your stomach,
you will be offered treatment for stomach cancer, not prostate
Signet ring cell cancer may be very aggressive.
Basal cell prostate
You might hear this described as adenoid cystic prostate cancer.
It can cause problems peeing, and it may be diagnosed after a transurethral resection of the prostate
Basal cell prostate cancer is very rare and not much is known
about it. We don’t know how aggressive it is. Some studies suggest
it isn’t very aggressive. But other studies suggest it might be
Sarcomas are rare cancers that can develop anywhere in the body,
including the prostate.
There are several types of prostate sarcomas. The most common in
adults is called leiomyosarcoma. There is another type called
rhabdomyosarcoma which may affect children and young men. This can
be treated with chemotherapy and radiotherapy.
Not all prostate sarcomas are aggressive.
Some men with prostate sarcoma will have another type of
prostate cancer as well, such as a glandular cancer . You may hear
this called a sarcomatoid carcinoma or a carcinosarcoma. These
cancers may be aggressive.
How are these
Different prostate cancers behave in different ways, and they
might respond differently to treatments. Some rare cancers
may be treated in a different way from typical prostate cancer.
Because these cancers are so rare, there isn’t enough evidence
to say which treatments will work best for all of them. If you have
any questions about your cancer speak to your doctor or nurse. They
will be able to explain your test results and talk you through your
possible treatment options.
Treatments for localised cancer
If your cancer is contained within the prostate (localised
prostate cancer), you may be offered treatments that aim to get rid
of the cancer such as surgery. But if your
cancer is very aggressive, there may be fewer treatment options
Some rare prostate cancers may be more likely to come back after
treatment than typical prostate cancer. If there’s a risk your
cancer could spread outside the prostate after treatment, you might
be given other treatments before, alongside or after your main
For example, if you have surgery, you might have radiotherapy and hormone therapy if there’s a risk that
not all of the cancer was removed, or if there are any signs that
it has come back. These treatments can help make the main treatment
more effective. But they can also increase the risk of side
If you have small cell prostate cancer you might have
chemotherapy before another treatment.
Treatments for locally advanced and advanced
All types of prostate cancer can spread outside the prostate –
to the area around the prostate (locally advanced prostate cancer),
and to other parts of the body, such as the bones (advanced
prostate cancer). But some rare prostate cancers may be more likely
to spread to places like the brain, lungs and liver.
therapy is often used to treat locally advanced and advanced
prostate cancer, but not all rare prostate cancers respond well to
it. This means you might have chemotherapy or
a combination of chemotherapy and hormone therapy.
Your treatment depends on your situation – for example, the kind
of cancer you have, your symptoms and any other treatments you’ve
already had. Speak to your doctor or nurse about what treatments
might be suitable for you.
When prostate cancer spreads to other parts of the body it can
cause symptoms, such as pain. But there are ways to manage these.
You may be offered chemotherapy if hormone therapy stops working
for you, or if hormone therapy isn’t suitable for your cancer.
In the UK, docetaxel (Taxotere®) is the standard chemotherapy treatment for men with advanced prostate
cancer that is no longer responding to hormone therapy. But you
might have a different chemotherapy if you have a rare cancer.
For example if you have small cell prostate cancer, you may have
carboplatin or cisplatin chemotherapy. You will have these together
with another chemotherapy, such as etoposide. You might have them
with another treatment such as hormone therapy. This depends on
Like all treatments, chemotherapy has side effects. And
different chemotherapy drugs may have different side effects. Macmillan Cancer Support has
more information about the side effects of these chemotherapy drugs
and ways of managing them.
Where can I
Being diagnosed with any kind of prostate cancer can be
frightening and overwhelming. If you are told you have a rare
prostate cancer you may worry about what this means, and feel
frustrated that there isn’t much information available about your
diagnosis and treatment.
No matter what you’re feeling or thinking, there is support available if you want it.
The Rarer Cancers Foundation
provides information and support to people affected by rare
cancers, including rare types of a more common cancer. You can also
join their online community.
Questions to ask your
doctor or nurse
- What type of prostate cancer do I have?
- Do I have both typical prostate cancer and a rare cancer?
- How far has my cancer spread?
- Will I need more tests, such as an MRI, CT or bone scan?
- What treatments are suitable for me?
- What are the side effects of the treatments?