Aggressive variant prostate cancer with multiple subcutaneous metastases: a case report

Area of Science:

• Oncology
• Urology

Background:

• Prostate cancer (PC) can transform into aggressive neuroendocrine variants.
• Hormone-sensitive prostate cancer (HSPC) treatments may be followed by castration resistance and disease progression.

Purpose of the Study:

• To report a case of aggressive variant prostate cancer (AVPC) with neuroendocrine differentiation.
• To discuss the implications of delayed diagnosis on treatment strategies and patient outcomes.

Main Methods:

• Case report of a 71-year-old male patient with metastatic prostate cancer.
• Review of biopsy specimens for neuroendocrine markers and genetic alterations (PTEN loss, TP53 overexpression).
• Analysis of treatment response to androgen deprivation therapy, apalutamide, radium-223, radiation therapy, and chemotherapy.

Main Results:

• Patient initially treated for hormone-sensitive prostate cancer progressed to castration resistance.
• Development of subcutaneous neuroendocrine prostate cancer metastases despite low prostate-specific antigen (PSA) levels.
• Biopsy confirmed aggressive variant prostate cancer with PTEN loss and TP53 overexpression.
• Patient received platinum-based chemotherapy but died 28 months after diagnosis.

Conclusions:

• Delayed diagnosis of aggressive variant prostate cancer may limit treatment options.
• Earlier identification through biopsy could potentially improve prognosis with timely platinum-based chemotherapy.
• This case underscores the importance of vigilant monitoring and re-biopsy in cases of treatment failure or atypical progression.