# Aggressive variant prostate cancer with multiple subcutaneous metastases: a case report

## TL;DR

A man with aggressive prostate cancer had delayed diagnosis of a rare neuroendocrine variant, which may have worsened his outcome.

## Contribution

This case highlights the importance of early detection of aggressive variant prostate cancer through biopsy to guide treatment.

## Key findings

- The patient developed subcutaneous metastases of neuroendocrine prostate cancer despite initial treatment.
- Phosphatase and tensin homolog loss and p53 overexpression confirmed aggressive variant prostate cancer.
- Delayed diagnosis of the aggressive variant likely limited treatment effectiveness and contributed to a poor prognosis.

## Abstract

A 71-year-old man with bone metastasis of hormone-sensitive prostate cancer was treated with androgen deprivation therapy and apalutamide. Radium-223 and radiation therapy were administered after it become castration resistant. Although prostate-specific antigen levels remained low, multiple subcutaneous metastases of neuroendocrine prostate cancer were observed. A review of the pre-treatment prostate needle biopsy revealed a small component with features suggestive of neuroendocrine differentiation. Phosphatase and tensine homolog loss and tumor protein p53 overexpression were observed, confirming the diagnosis of aggressive variant prostate cancer. Platinum-based chemotherapy was administered; however, the patient died 28 months after diagnosis. In this case, if the diagnosis of aggressive variant prostate cancer had been made at an earlier time by biopsy specimens, there might have been a possibility to improve the prognosis by the earlier introduction of the platinum-based regimen.

The online version contains supplementary material available at 10.1007/s13691-024-00673-7.