Abstract: In August, 2018, a 67-year-old man presenting progressive dysuria and defecation difficulty for 7 months went to our hospital. tPSA was 24.50 ng/mL. MRI examination suggested prostate cancer, and the prostate biopsy confirmed it. Gleason score was 9 (5+4), and TNM stage after admission was cT4N0M0. Radical prostatectomy was performed after castration, combined with docetaxel chemotherapy. After operation, the patient was diagnosed as high-risk localized prostate cancer with pT4N0M0 and Gleason score 9. Local radiotherapy and castration were then given to the patient. Chest CT and PET-CT in June 2019 suggested multiple lymph node metastasis and bone metastasis. A cervical lymph node biopsy was then performed on June 10th, 2019, with CgA (+), Syn (+), PSMA (+), and PSA (+), which was consistent with prostate cancer metastasis. So the patient was diagnosed as large cell neuroendocrine carcinoma of the prostate. The patient has been treated with Abiraterone since June, 2019, which was effective in the first 2 weeks, but after 6 weeks of treatment, PSA rose again to 26.20 ng/mL. Gene detection results suggested AR amplification, so we replaced Abiraterone with docetaxel combined with cisplatin. Chest CT on November 5th, 2019 showed that the size of mediastinal and hilar lymph nodes were significantly reduced, and the pericardial effusion and pleural effusion were obviously absorbed. The patient was still alive at the end of the follow up. ECOG score was 0.

Key words: prostate, large cell, neuroendocrine carcinoma