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This case examines the complications in diagnosing treatment-emergent neuroendocrine prostate cancer post-therapy.

May 9, 2026Open Access

Diagnostic Challenge in Treatment-Emergent Neuroendocrine Prostate Cancer: A Case Requiring Prostate Rebiopsy After an Inconclusive Metastatic Lung Biopsy

Key Points

This case examines the complications in diagnosing treatment-emergent neuroendocrine prostate cancer post-therapy.
Reported a case of an 80-year-old man with lung lesions and prostate adenocarcinoma treated with enzalutamide.
Performed transbronchial lung biopsy followed by prostate rebiopsy after initial inconclusive results.
Treated the confirmed t-NEPC with carboplatin, etoposide, and durvalumab.
Initial lung biopsy showed poorly differentiated carcinoma without a confirmed primary site.
Prostate rebiopsy confirmed the diagnosis of t-NEPC due to history of treatment with androgen receptor inhibitors.
Patient later succumbed to carcinomatous meningitis.

Abstract

Treatment-emergent neuroendocrine prostate cancer (t-NEPC) is an aggressive variant arising from lineage plasticity after androgen receptor pathway inhibitor therapy. We report an 80-year-old man with metastatic prostate adenocarcinoma treated with enzalutamide who developed lung lesions despite stable prostate-specific androgen levels. A transbronchial lung biopsy revealed poorly differentiated carcinoma without confirmation of the primary site. Suspecting t-NEPC based on his treatment history, a prostate rebiopsy confirmed the diagnosis. He was treated with carboplatin, etoposide, and durvalumab, but he later succumbed to carcinomatous meningitis. This case highlights the limitations of small metastatic biopsies and the importance of considering phenotypic transformation during prostate cancer treatment.

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