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CASE REPORT article

Front. Oncol.

Sec. Genitourinary Oncology

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1576048

This article is part of the Research TopicGenetic and Genomic Alterations in CancerView all articles

Case Report: Genomic Insights into Prostate Adenocarcinoma Transdifferentiation to Carcinosarcoma due to Lineage Plasticity

Provisionally accepted
Tomohiro FukuiTomohiro Fukui1Arinobu FukunagaArinobu Fukunaga1Yuki TeramotoYuki Teramoto2Maki FujiwaraMaki Fujiwara1Kensuke HikamiKensuke Hikami1Takuro SunadaTakuro Sunada1Kei MizunoKei Mizuno1Yuki KitaYuki Kita1Takayuki SumiyoshiTakayuki Sumiyoshi1Takayuki GotoTakayuki Goto1Ryoichi SaitoRyoichi Saito1Takashi KobayashiTakashi Kobayashi1Shusuke AkamatsuShusuke Akamatsu3*
  • 1Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • 2Department of Diagnostic Pathology, Faculty of Medicine, Kyoto University, Kyoto, Kyōto, Japan
  • 3Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan

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In prostate cancer, it is recognized that adenocarcinoma can transdifferentiate into neuroendocrine prostate cancer (NEPC) owing to lineage plasticity; however, transdifferentiation into other histological types remains uncertain. We present a case of a patient who underwent surgery for adenocarcinoma, which later recurred as prostate carcinosarcoma. Genomic analysis revealed a TMPRSS2-ERG fusion, confirming a common clonal origin and transdifferentiation from adenocarcinoma to carcinosarcoma. Additionally, we identified a frameshift mutation in TP53 and the loss of PTEN and RB1. Transcriptome analysis revealed enriched epithelial-mesenchymal transition and immune-related pathways, a pattern distinct from both adenocarcinoma and NEPC. To our knowledge, this is the first report that comprehensively evaluated the clonal origin of the rare prostate carcinosarcoma and characterized it using genomic and transcriptomic sequencing. It enhances our understanding of prostate cancer lineage plasticity and highlights the importance of developing novel therapies specifically targeted at prostate carcinosarcoma.

Keywords: prostate cancer, Carcinosarcoma, Lineage plasticity, transdifferentiation, Genomic Analysis, case report

Received: 14 Feb 2025; Accepted: 18 Aug 2025.

Copyright: © 2025 Fukui, Fukunaga, Teramoto, Fujiwara, Hikami, Sunada, Mizuno, Kita, Sumiyoshi, Goto, Saito, Kobayashi and Akamatsu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Shusuke Akamatsu, Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan

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