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Published on: November 19, 2019
Neuroendocrine Transformation Without PSA Elevation in High-Risk Metastatic Castration-Sensitive Prostate Cancer
Yoshihiro Nakagami1, Shintaro Ohnuma2, Masashi Tamaoka1
1Department of Urology Showa Medical University School of Medicine Tokyo Japan.
IJU Case Reports
|June 8, 2026
Summary
Metastatic castration-sensitive prostate cancer can transform into aggressive neuroendocrine prostate cancer. This transformation may occur without a rise in prostate-specific antigen levels, challenging standard monitoring methods.
Area of Science:
- Oncology
- Urology
Background:
- Neuroendocrine prostate cancer (NEPC) is a rare, aggressive variant.
- Metastatic castration-sensitive prostate cancer (mCSPC) typically responds to androgen deprivation therapy.
Purpose of the Study:
- To report a case of mCSPC transforming into NEPC.
- To highlight diagnostic and monitoring challenges in advanced prostate cancer.
Main Methods:
- Case report of an 86-year-old male with advanced prostate cancer.
- Review of clinical presentation, imaging, biopsy, treatment, and autopsy findings.
Main Results:
- Patient diagnosed with high-risk mCSPC, treated with abiraterone acetate.
- Developed liver metastases with stable prostate-specific antigen (PSA) levels.
- Autopsy confirmed widespread NEPC metastases.
Conclusions:
- mCSPC can transform into NEPC without PSA elevation.
- Aggressive progression can occur despite androgen receptor suppression.
- PSA monitoring has limitations in detecting NEPC transformation.
