神經內分泌前列腺癌：病例報告

林晏頎、邵翊紘

林口長庚紀念醫院外科部 泌尿科系

Neuroendocrine Prostate Cancer, a case report

Yen-Chi Lin, I-Hung Shao

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

Background: Neuroendocrine Prostate Cancer (NEPC) is an uncommon and exceptionally aggressive type of prostate cancer. Unlike the more prevalent adenocarcinomas, which originate from cells responsible for creating prostate fluid, NEPC arises in neuroendocrine cells. These specialized cells produce hormones in response to neural signals from the nervous system. NEPC presents unique challenges due to its aggressiveness and distinct cellular origin. Researchers have identified several frequently mutated genes associated with NEPC, including TP53, RB1, and PTEN. While de novo NEPC is rare (accounting for only 0.5–1% of newly diagnosed prostate cancers), most cases result from the transformation of castrate-resistant adenocarcinoma. Effective treatment strategies for NEPC remain a critical area of research and clinical focus. 

Case presentation: A 78-year-old man with prostate adenocarcinoma with lung and bone metastasis and received androgen deprivation therapy (ADT) since 2013. He suffered from constipation for 1 month.

Associated symptoms included dysuria and urinary retention. He went to local medical department for help, digital rectal exam showed palpable stiff nodule at anterior half of rectum at prostate level. CT showed rectal tumor, and tumor biopsy was done, pathological report showed poorly differentiated carcinoma with neuroendocrine marker, suspected neuroendocrine tumor, so he was referred to our hospital for further management. His prostatic specific antigen level <0.025 ng/ml two months ago. Colonoscopy revealed that rectal submucosal induration tumor over anterior aspect, and transrectal ultrasound guide prostate biopsy showed poorly differentiated carcinoma, Immunohistochemical study showed poorly differentiated prostatic adenocarcinoma, Gleason score 4 + 5 = 9, with squamous and neuroendocrine differentiation.

Conclusions: NEPC is an increasingly acknowledged histologic subtype of prostate cancer, often emerging in advanced stages of the disease as a response to treatment resistance. Current diagnosis relies on tissue biopsy, with no established therapy effectively targeting the molecular characteristics of NEPC.