Introduction: Neuroendocrine/small-cell prostate cancer (NEPC) is a rare and aggressive subtype of prostate cancer, which typically develops after prolonged treatment for metastatic castration-resistant disease, but can, less commonly, occur de novo. Case Presentation: We describe a case of de novo NEPC in a tumor with mixed pathology including acinar adenocarcinoma and neuroendocrine/small-cell carcinoma with rapid progression of metastatic disease. Despite initiation of treatment with androgen deprivation therapy (ADT) and chemotherapy, the patient continued to exhibit progression leading to multiple complications including a large bowel obstruction and ultimately progressive hepatic metastases resulting in liver failure. Conclusion: This case illustrates the clinical presentation and highly aggressive nature of de novo NEPC. Recognizing atypical clinical progression in prostate cancer is critical for the detection of NEPC; however, despite early identification and initiation of treatment, the prognosis remains poor, thus highlighting the need for further study into NEPC biology and novel therapeutic approaches.
Case reports in oncological medicine. 2024 Sep 17*** epublish ***
Aryan Dalal, Sean Clark-Garvey, Andrew Gdowski, Sophia Zhang, Sara E Wobker, Steven P Rowe, Ersan Altun, Himisha Beltran, Matthew I Milowsky
Department of Biostatistics University of North Carolina, Chapel Hill, North Carolina, USA., Lineberger Comprehensive Cancer Center University of North Carolina, Chapel Hill, North Carolina, USA., Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., Department of Pathology and Laboratory Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., Department of Radiology University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., Department of Medical Oncology Dana-Farber Cancer Institute Harvard Medical School, Boston, Massachusetts, USA.