Mechanistic insights and molecular therapy for neuroendocrine prostate cancer

Neuroendocrine prostate cancer (NEPC) is a highly aggressive subtype of prostate cancer with a poor prognosis, strongly associated with androgen deprivation therapy. Recent studies have revealed that neuroendocrine transdifferentiation in NEPC is influenced by both transcription factor activity and epigenetic regulation. This review systematically discusses the origin hypotheses, molecular subtypes, driving mechanisms, and therapeutic strategies of NEPC, focusing on the critical roles of transcription factors and epigenetic modifications in lineage plasticity. Furthermore, we summarize the latest advancements in targeted therapies. By integrating multiomics data and preclinical models, this review provides a theoretical foundation for precision treatment of NEPC.