Neuroendocrine differentiation in castration-resistant prostate cancer: A case report

The most common type of prostate cancer is acinar adenocarcinoma, which is androgen-dependent and, therefore, treated with chemical or surgical castration and androgen receptor inhibition. However, the disease usually progresses to castration-resistant prostate cancer (CRPC). A neuroendocrine pattern is frequently observed in the cellular composition of CRPC, which is considered to emerge as an effect of androgen deprivation therapy. This is the case report of a 69-year-old patient with prostate adenocarcinoma, who, after an initial period of disease control with radiotherapy and antiandrogens, was diagnosed with CRPC with high levels of prostate-specific antigen (PSA), unresponsive to androgen inhibition, with accompanying lung and osseous metastases. Bronchial biopsy of the lung metastasis revealed infiltration by non-small-cell adenocarcinoma of prostatic origin with neuroendocrine characteristics. On somatostatin receptor scintigraphy with ^99mTc-octreotide, there was high uptake by almost all known lung and osseous metastases. The patient was subsequently treated with a combination of docetaxel and octreotide, and a partial response was observed 6 months later, with reduction of the PSA level and the size of the lung metastasis. The aim of the present study was to provide a clinical example of the previously demonstrated, in vitro and in vivo, synergistic antitumor activities of docetaxel and octreotide in cases of CRPC selected by means of histological confirmation of their neuroendocrine nature and somatostatin receptor scintigraphy.