[Prostatic carcinoma that arose with hearing loss: a case report]

Area of Science:

• Oncology
• Urology
• Neurology

Background:

• Small-cell carcinoma (SCC) is a rare and aggressive malignancy.
• Prostate cancer typically presents with elevated prostate-specific antigen (PSA) and is often adenocarcinoma.
• Atypical presentations of prostate cancer can complicate diagnosis.

Observation:

• A 69-year-old male presented with tinnitus, vertigo, and hearing loss, later diagnosed with small-cell carcinoma (SCC) involving the skull base and prostate.
• Immunohistochemistry revealed SCC markers (NSE, NCAM) alongside prostate markers (PSA, AR) in tumor cells.
• The patient's serum PSA and NSE levels were significantly elevated.

Findings:

• The patient showed partial response to maximum androgen blockade (MAB), with improved hearing, reduced lymph nodes, and decreased serum markers.
• Despite initial response, the cancer progressed, necessitating changes in treatment to docetaxel/estramustine.
• The case demonstrates that prostate SCC can express androgen receptors and respond temporarily to androgen ablation.

Implications:

• Small-cell carcinoma of the prostate (SCCP) should be considered in the differential diagnosis of patients with atypical symptoms and elevated PSA.
• The AR-positive nature of this SCCP suggests a potential role for androgen-targeted therapies, even in non-adenocarcinoma histology.
• This case underscores the complexity of diagnosing and managing rare prostate cancer subtypes.