攝護腺癌治療誘發之快速進展小細胞神經內分泌癌：病例報告

王嘉源¹、林巧文¹、林嘉緯¹、高國維¹、張東平¹、李淑文¹、賴昱維¹、蕭毅君¹、薛又仁²、陳修聖¹、邱文祥³

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²臺北市立聯合醫院和平婦幼院區 外科部 泌尿科；³新光醫療財團法人新光吳火獅紀念醫院 外科部 泌尿科

Rapid Progression to Treatment-Emergent Small Cell Neuroendocrine Carcinoma of the Prostate: A Case Report

Chia-Yuan Wang¹, Chyau-Wen Lin¹, Chia-Wei Lin¹, Kuo-Wei Kao¹, Tung-Ping Chang¹, Yu-Wei Lai¹, Yi-Chun Hsiao¹, Thomas Y. Hsueh², Shiou-Sheng Chen¹, Allen W. Chiu³

¹Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan; ²Division of Urology, Department of Surgery, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; ³Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Introduction: Neuroendocrine prostate cancer (NEPC) is an aggressive variant that often emerges after androgen deprivation therapy (ADT) for prostatic adenocarcinoma, a phenomenon known as lineage plasticity. We report a case of rapid clinical deterioration and bladder neck obstruction due to small cell neuroendocrine transformation.

Case Presentation: A 73-year-old male with metastatic prostate adenocarcinoma (cT2cN1M1b) was treated with Leuprorelin and Bicalutamide. One month after undergoing Thulium laser prostate vaporization for acute urinary retention (AUR) and hematuria, he presented with recurrent AUR. Cystoscopy revealed rapidly growing protruding tumors at the bladder neck. Transurethral resection of the bladder tumor (TURBT) was performed. Pathological examination confirmed small cell neuroendocrine carcinoma. Immunohistochemical staining was positive for CD56 and Synaptophysin, while negative for NKX3.1, Chromogranin A, and GATA3, indicating a complete loss of prostatic lineage markers and aggressive neuroendocrine transformation.

Conclusion: This case highlights the diagnostic challenge of t-NEPC, which can manifest as rapid local progression despite ADT. Early recognition through repeat biopsy and IHC staining is crucial, as the management of NEPC requires a shift from hormonal manipulation to platinum-based chemotherapy.