[A Case of Metastatic Prostate Cancer with Neuroendocrine Differentiation with Long-Term Survival after Multidisciplinary Therapy]

Koki Fujita ¹, Minoru Kato ¹, Yuki Kosugi ¹

⁰The Department of Urology, Osaka Metropolitan University Hospital.

Hinyokika Kiyo. Acta Urologica Japonica +

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July 5, 2024

View abstract on PubMed

Summary

This case study highlights a rare progression of prostate cancer to neuroendocrine prostate cancer (NEPC). Effective treatment with cisplatin and irinotecan chemotherapy led to complete remission in metastatic NEPC.

Area Of Science

Oncology
Urology
Pathology

Background

A 74-year-old man presented with urinary retention and was diagnosed with advanced prostate adenocarcinoma (Gleason Score 4+4, cT3aN1M0).
Initial treatment with combined androgen blockade led to a decline in prostate-specific antigen (PSA).
The patient later developed castration-resistant prostate cancer (CRPC) with local progression despite non-elevated PSA.

Purpose Of The Study

To report a rare case of prostate cancer progression to neuroendocrine prostate cancer (NEPC).
To describe the diagnostic challenges and treatment outcomes for metastatic NEPC.
To emphasize the importance of considering NEPC in advanced prostate cancer cases with atypical presentations.

Main Methods

Diagnosis involved PSA levels, computed tomography (CT) scans, palliative radiation therapy, and bilateral orchiectomy with pathological examination.
Neuroendocrine prostate cancer (NEPC) was confirmed via rebiopsy and pathological examination of testicular tumor.
Treatment consisted of chemotherapy with cisplatin and irinotecan following orchiectomy.

Main Results

The patient developed metastatic disease to the lungs and testicle, with elevated neuron-specific enolase (NSE) but normal PSA.
Pathological examination post-orchiectomy confirmed metastatic neuroendocrine prostate cancer (NEPC).
Chemotherapy resulted in a complete response of lung lesions and normalization of NSE levels, with no recurrence for 4 years.

Conclusions

Neuroendocrine prostate cancer (NEPC) can arise from conventional prostate adenocarcinoma, presenting diagnostic challenges.
Prompt diagnosis and aggressive chemotherapy (cisplatin/irinotecan) can achieve durable remission in metastatic NEPC.
This case underscores the importance of comprehensive evaluation for NEPC in advanced prostate cancer patients with treatment resistance or atypical markers.