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Background <p>Large-cell neuroendocrine carcinoma of the prostate is an extremely rare disease and classified into two subtypes: <i>de&#xa0;novo</i> and treatment-induced large-cell neuroendocrine carcinoma that arises from adenocarcinoma via lineage plasticity in response to long-term hormonal therapy. Although successful outcomes have been reported for some <i>de&#xa0;novo</i> large-cell neuroendocrine carcinoma cases of the prostate, the prognosis of large-cell neuroendocrine carcinoma of the prostate remains poor.</p> Case presentation <p>A 69-year-old East Asian man diagnosed with adenocarcinoma of the prostate had been treated with androgen deprivation therapy and androgen receptor signaling inhibitors for 4.5 years without elevation of prostate-specific antigen levels. He complained of lumbar, abdominal, and perineal pain and was diagnosed as having treatment-induced large-cell neuroendocrine carcinoma of the prostate with cT4N1M0 on clinicopathological examination. Total pelvic exenteration and pelvic lymph node dissection were performed, followed by adjuvant chemoradiotherapy, which resulted in local recurrence. Since comprehensive genomic profiling of the surgical specimen showed it was microsatellite instability-high, pembrolizumab was administered, and complete remission was achieved. The patient has shown no signs of recurrence for more than 2 years after the diagnosis of large-cell neuroendocrine carcinoma of the prostate.</p> Conclusions <p>Pembrolizumab combined with surgical resection, radiotherapy, and systemic chemotherapy may improve the prognosis of patients with treatment-induced large-cell neuroendocrine carcinoma of the prostate, although further accumulation of cases is needed.</p>

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Successful treatment of large-cell neuroendocrine carcinoma of the prostate with pembrolizumab: a case report

  • 期刊论文

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  • 发表日期：

    2025年11月18日

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  • Erika Yamashita,
  • Shingo Ashida,
  • Rie Yoshimura,
  • Ryohei Iga,
  • Yoshitaka Kurano,
  • Shinkuro Yamamoto,
  • Tsutomu Shimamoto,
  • Hideo Fukuhara,
  • Satoshi Fukata,
  • Atsushi Kurabayashi,
  • Takashi Karashima,
  • Keiji Inoue

摘要

Background

Large-cell neuroendocrine carcinoma of the prostate is an extremely rare disease and classified into two subtypes: de novo and treatment-induced large-cell neuroendocrine carcinoma that arises from adenocarcinoma via lineage plasticity in response to long-term hormonal therapy. Although successful outcomes have been reported for some de novo large-cell neuroendocrine carcinoma cases of the prostate, the prognosis of large-cell neuroendocrine carcinoma of the prostate remains poor.

Case presentation

A 69-year-old East Asian man diagnosed with adenocarcinoma of the prostate had been treated with androgen deprivation therapy and androgen receptor signaling inhibitors for 4.5 years without elevation of prostate-specific antigen levels. He complained of lumbar, abdominal, and perineal pain and was diagnosed as having treatment-induced large-cell neuroendocrine carcinoma of the prostate with cT4N1M0 on clinicopathological examination. Total pelvic exenteration and pelvic lymph node dissection were performed, followed by adjuvant chemoradiotherapy, which resulted in local recurrence. Since comprehensive genomic profiling of the surgical specimen showed it was microsatellite instability-high, pembrolizumab was administered, and complete remission was achieved. The patient has shown no signs of recurrence for more than 2 years after the diagnosis of large-cell neuroendocrine carcinoma of the prostate.

Conclusions

Pembrolizumab combined with surgical resection, radiotherapy, and systemic chemotherapy may improve the prognosis of patients with treatment-induced large-cell neuroendocrine carcinoma of the prostate, although further accumulation of cases is needed.