Small cell neuroendocrine prostate cancer with adenocarcinoma components-case report and literature review.

Small cell neuroendocrine prostate cancer (SCNC) is a rare aggressive type of neuroendocrine prostate cancer (NEPC) characterized by aggressive clinical course and lack of response to hormone therapy.

We present a case report of a 60-year-old man diagnosed with a histologically confirmed primary metastatic (bone, lymph nodes and visceral) SCNC with small components of an adenocarcinoma with clinical symptoms mimicking an acute prostatitis. Of note, serum based neuroendocrine markers (carcinoembryonic antigen, chromogranin A) were negative and the patient had a prostate-specific antigen (PSA) elevation. Genetic testing of tumor tissue revealed breast cancer gene 2 (BRCA2) copy number loss and a retinoblastoma gene (RB1) mutation reflecting again the aggressiveness of the disease. Germline testing for the BRCA2 copy number loss was unremarkable. After 6 cycles of carboplatin and etoposide in combination with androgen deprivation therapy (ADT) the Eastern Cooperative Oncology Group (ECOG) performance status has improved from 3 to 0, in addition the patient was free of pain. In line with clinical improvement, both prostate-specific membrane antigen (PSMA) and fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed a significant reduction of metastatic load. Currently, the patient is treated with ADT plus apalutamide.

We demonstrate for the first time a case of a primary metastatic SCNC with adenocarcinoma components successfully treated by the combination of platinum-based chemotherapy plus hormonal therapy. In addition, we provide a literature overview on management of SCNC as there is no standard treatment established for this disease.

Translational andrology and urology. 2024 May 27 [Epub]

Nastasiia Artamonova, Angela Djanani, Andreas Schmiederer, Iris Pipp, Eva Compérat, Gianpaolo di Santo, Friedrich Aigner, Andreas von der Heidt, Isabel Heidegger

Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria., Clinical Pathology and Cytodiagnostics, Tirol-Kliniken, Innsbruck, Austria., Department of Pathology, Medical University Vienna, Vienna, Austria., Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria., Department of Radiology, Medical University Innsbruck, Innsbruck, Austria., Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria.