Neuroendocrine prostate cancer after hormonal therapy: Knowing is half the battle
© 2014, American Society for Microbiology. All Rights Reserved. A healthy man undergoing screening for prostate cancer at age 55 years was found to have a prostate-specific antigen (PSA) of 19 ng/mL, and a subsequent biopsy disclosed Gleason 34 prostatic adenocarcinoma. He received intensity-modulated radiation therapy plus 1 year of leuprolide. Following biochemical recurrence approximately 2 years later, he then received intermittent hormonal therapy until the development of overt metastatic disease 6 years later. His tumor did not respond to the addition of bicalutamide or protocol-based treatment involving a novel agent, and he developed rapidly progressive, symptomatic disease. He subsequently received docetaxel, abiraterone, and prednisone as part of a clinical trial that achieved symptomatic, biochemical, and radiographic response (clinical course summarized in Table 1). Following 10 cycles of docetaxel, he stayed on abiraterone and prednisone for approximately 1 year until biochemical progression and another 6 months until radiologic change was noted. When he was noted to have a mild increase in the size of metastatic disease tolymphnodes not meetingRECISTcriteria for progression, he underwent a biopsy consistent with castration-resistant prostatic adenocarcinoma (Fig 1A). Three months later, he developed both symptomatic and radiographic progression, including the development of liver metastases. Biopsy of a liver metastasis revealed neuroendocrine prostate cancer (NEPC; Fig 1B).
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