Narrative review of challenges in the management of advanced neuroendocrine prostate cancer

Area of Science:

• Oncology
• Genitourinary Oncology
• Cancer Biology

Background:

• Androgen receptor targeted agents (ARTAs) have led to an increased incidence of treatment-related neuroendocrine prostate cancer (t-NEPC).
• Currently, no standard effective treatment exists for t-NEPC.
• Advances in genomic and molecular medicine are uncovering critical biological features of NEPC.

Purpose of the Study:

• To review recent research findings on treatment-related neuroendocrine prostate cancer (t-NEPC).
• To introduce ongoing therapeutic developments for t-NEPC.
• To highlight the heterogeneity of t-NEPC and its clinical implications.

Main Methods:

• Review of recent scientific literature on t-NEPC.
• Analysis of pre-clinical in vivo and in vitro research models.
• Examination of genomic and molecular findings in NEPC.

Main Results:

• t-NEPC exhibits significant heterogeneity in androgen receptor (AR), neuroendocrine (NE) marker, and cell cycle gene expression.
• This heterogeneity has potential clinical implications for prognosis and treatment selection.
• Several potential drug targets have been identified, with early clinical trials underway.

Conclusions:

• Future treatment optimization for t-NEPC requires precise disease classification and biomarker-driven patient selection.
• Ongoing research and therapeutic developments hold promise for novel treatment strategies.
• Understanding the heterogeneity of t-NEPC is crucial for advancing patient care.