CASE REPORT article
Front. Oncol.
Sec. Genitourinary Oncology
De Novo Small Cell Neuroendocrine Carcinoma of the Prostate with Extremely Elevated PSA and Gleason Score 5+5: A Case Report
Provisionally accepted
- Beijing University of Chinese Medicine, Beijing, China
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Objectives: To report an exceptionally rare case of de novo small cell neuroendocrine carcinoma of the prostate (SCNEPC) presenting with unprecedented PSA elevation and Gleason score 5+5, and to describe the remarkable treatment response achieved with multimodal therapy. Case: A 72-year-old man presented with PSA 982 ng/mL and extensive skeletal metastases. Prostate biopsy revealed mixed histology comprising small cell neuroendocrine carcinoma (Gleason 5+5=10) in seven cores and adenocarcinoma (Gleason 5+4=9) in three cores (T3bN1M1). The patient received six cycles of cisplatin-etoposide chemotherapy combined with goserelin and apalutamide. Post-treatment evaluation demonstrated profound biochemical response with PSA declining to 0.90 ng/mL (99.9% reduction), ProGRP decreasing to 75.7 pg/mL, and testosterone suppressed to castrate levels. Imaging confirmed substantial lesion regression with no new metastases. The patient experienced dramatic clinical improvement and remains alive with controlled disease under ongoing androgen deprivation therapy. Conclusion: This represents the first reported case of de novo SCNEPC with Gleason score 5+5, demonstrating that intensive multimodal therapy combining platinum-based chemotherapy with contemporary androgen receptor pathway inhibition can achieve profound and sustained responses in this aggressive variant typically associated with dismal outcomes. The substantial adenocarcinoma component may have contributed to the exceptional treatment response.
Keywords: Apalutamide, chemotherapy, Gleason grade, neuroendocrine prostate cancer, Prostate-Specific Antigen, small cell carcinoma
Received: 06 Nov 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Tang, Cai, Jiang, Qiao and Gao. 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: Yiwen Tang
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