- Nature Reviews Urology 综述（2026-10-19 在线；作者含病理医生 Katrina Collins、Liang Cheng），通讯作者 2026-11-01 在 X 上 #gupath 推送。
- 覆盖的少见类型：黏液腺癌、导管内癌、导管腺癌、神经内分泌前列腺癌（含治疗后出现的小细胞神经内分泌癌）、肉瘤样癌、基底细胞癌，合计不到全部前列腺癌的 5%。
- 核心观点：「少见」多半是取材问题——转移灶活检做得少，治疗后出现的表型在日常工作中难得一见；这些类型侵袭性强、转移方式不典型、对常规治疗反应差，PSA 筛查易漏，常晚期才诊断。
- 对病理的意义：多参数 MRI、免疫组化和基因组谱是识别和风险分层的关键；DNA 修复缺陷、RB1/TP53 缺失、错配修复缺陷在部分亚型富集，提示报告中写明组织学类型并推动分子检测。原文为订阅内容，本站仅收要点（Key points）与摘要。
收录范围：出版社页面公开的要点（Key points）与 PubMed 摘要，中英对照，并列出原文章节目录。原文为 Springer Nature 订阅内容，本站未获全文与图表。
要点（Key points）
- 前列腺癌的少见组织学类型仍未得到充分认识，具有各自独特的形态、分子和临床特征，常伴侵袭性生物学行为、不典型转移方式和较差的预后。
- 基于 PSA 的筛查存在局限，导致诊断延迟，这些类型常在晚期才被发现，凸显影像学、病理专业判断和分子谱分析的重要性。
- DNA 损伤修复缺陷、TP53 与 RB1 缺失、错配修复缺陷等基因组改变在部分亚型中富集，为标准雄激素受体靶向策略之外提供了潜在治疗机会。
- 目前少见类型前列腺癌的处理建议大多由腺泡腺癌外推而来，针对这些少见亚型的前瞻性试验和指南级证据仍然匮乏。
- 提高诊断精准度、整合胚系与体细胞检测、建立协作性前瞻性登记，是优化少见组织学类型前列腺癌患者临床管理、推进精准医学的关键。
摘要
相对少见的前列腺癌组织学类型合计占全部前列腺癌的 5% 以下，包括黏液腺癌、导管内癌、导管腺癌、神经内分泌前列腺癌（含治疗后出现的小细胞神经内分泌癌）、肉瘤样癌和基底细胞癌。这些类型彼此之间、以及与最常见的腺泡腺癌相比，都具有不同的形态、分子和临床特征。人们感觉它们「少见」，往往反映的是取材局限而非真实的生物学发生率：由于转移灶活检开展不多，许多治疗后出现的表型在日常工作中很少遇到。这些类型表现出侵袭性行为、不典型的转移方式，以及对常规治疗反应降低。尽管临床意义重要，这些病种在标准指南和临床试验中仍代表性不足。导管、黏液、导管内、神经内分泌和肉瘤样癌等组织学类型及亚型带来诊断和治疗上的挑战，且常规 PSA 筛查存在局限，因此它们常在晚期才被诊断。多参数 MRI、免疫组化和基因组谱分析是准确识别和风险分层的关键工具。各组织学类型特有的基因组改变——包括 DNA 修复缺陷、RB1 与 TP53 缺失以及错配修复基因突变——提供了潜在的治疗机会，但治疗建议仍主要由腺泡腺癌外推。有限的回顾性数据提示，少见组织学类型患者的结局比典型腺泡腺癌更差，亟需前瞻性登记和专门的临床试验。少见组织学类型前列腺癌是一个未被充分认识的致病和致死来源。提高诊断精准度、纳入分子谱分析以及协作开展数据收集，是制定循证策略的必要条件。
原文章节（仅列目录，正文未获取）
引言；WHO 分类（2022 年第 5 版）；组织学亚型的检出；组织学亚型与转移；各少见类型的具体特点；未满足的需求与患者；未来方向；结论。
- Nature Reviews Urology review (online 19 October 2026; authors include pathologists Katrina Collins and Liang Cheng), shared on X under #gupath on 1 November 2026.
- Histologies covered: mucinous adenocarcinoma, intraductal carcinoma, ductal adenocarcinoma, neuroendocrine prostate cancer (including treatment-emergent small-cell neuroendocrine carcinoma), sarcomatoid carcinoma and basal cell carcinoma, together <5% of prostate cancers.
- Core message: their rarity largely reflects sampling, as metastatic biopsies are infrequent; they behave aggressively, metastasize atypically, respond poorly to conventional therapy, escape PSA screening and are often diagnosed late.
- For pathology: MRI, immunohistochemistry and genomic profiling are key; DNA repair defects, RB1/TP53 loss and mismatch repair deficiency are enriched in some subtypes. Subscription content — key points and abstract only.
Scope: the publicly visible Key points and the PubMed abstract, plus the section list of the original. The article is Springer Nature subscription content; the full text and figures were not obtained.
Key points
- Rare histologies of prostate cancer remain under-recognized and exhibit distinct morphological, molecular and clinical features, frequently associated with aggressive behaviour, atypical metastatic patterns and inferior outcomes.
- PSA-based screening exhibits limitations leading to delayed diagnosis and these histologies often present at an advanced stage, underscoring the importance of imaging, pathology expertise and molecular profiling.
- Genomic alterations such as DNA damage repair defects, TP53 and RB1 loss, and mismatch repair deficiency are enriched in selected subtypes, providing potential therapeutic opportunities beyond standard androgen-receptor-directed strategies.
- Current management recommendations for rare prostate cancer histologies are largely extrapolated from acinar adenocarcinoma, as prospective trials and guideline-level evidence specific to the rare subtypes remain scarce.
- Improved diagnostic precision, integration of germline and somatic testing, and collaborative prospective registries are essential to optimize clinical management and advance precision medicine for patients with a rare prostate cancer histology.
Abstract
Relatively rare histologies of prostate cancer collectively account for <5% of all prostate cancers and comprise mucinous adenocarcinoma, intraductal carcinoma, ductal adenocarcinoma, neuroendocrine prostate cancer (including treatment-emergent small-cell neuroendocrine carcinoma), sarcomatoid carcinoma and basal cell carcinoma. These histologies have distinct morphological, molecular and clinical features from each other and the most common histological type, acinar adenocarcinoma. The perceived rarity of these histologies often reflects sampling limitations rather than biological prevalence, as many treatment-emergent phenotypes are seldom encountered in routine practice owing to the infrequent use of metastatic biopsies. These histologies demonstrate aggressive behaviour, atypical metastatic patterns and reduced responsiveness to conventional therapies. Despite their clinical importance, these entities remain under-represented in standard guidelines and clinical trials. Histological types and subtypes, such as ductal, mucinous, intraductal, neuroendocrine and sarcomatoid carcinomas, pose diagnostic and therapeutic challenges, and conventional screening with PSA exhibits limitations, so they are often diagnosed at advanced stages. Multiparametric MRI, immunohistochemistry and genomic profiling are crucial tools for accurate recognition and risk stratification. Histological type-specific genomic alterations, including DNA repair deficiencies, RB1 and TP53 loss, and mismatch repair mutations, provide potential therapeutic opportunities, but treatment recommendations are still largely extrapolated from acinar adenocarcinoma. Limited retrospective data suggest worse outcomes for patients with a rare histology than those with typical acinar adenocarcinoma, highlighting the urgent need for prospective registries and dedicated clinical trials. Rare histologies of prostate cancer are an under-recognized source of morbidity and mortality. Improved diagnostic precision, incorporation of molecular profiling and collaborative data collection efforts are essential to develop evidence-based strategies.
Sections of the original (table of contents only; full text not obtained)
Introduction; WHO Classification 2022 – 5th edition; Detecting histological subtypes; Histological subtypes and metastasis; Specifics of rare histologies; Unmet needs and the patient; Future directions; Conclusions.