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Internal Medicine

Training Level

Resident PGY 1


Henry Ford Hospital


Here we describe the case of a 57yo male who was diagnosed with stage IV prostate cancer, which subsequently transformed into small cell carcinoma of the prostate found on histology. He initially presented with fatigue and feeling poor overall for which he was diagnosed with metastatic prostate adenocarcinoma with PSA of 58.4. At that time, CT imaging showed metastatic disease with lymphadenopathy in the retro-peritoneum and pelvis. He was treated with combined androgenic blockade plus Taxotere and Prednisone, which controlled his disease for a short time. Four years after his initial prostate cancer diagnosis he began to again feel poorly with increased weight loss and N/V. Supra-clavicular lymph node biopsy was done and per histological report showed transformation of his prostate adenocarcinoma into small cell carcinoma of the prostate. He was treated with Carboplatin and 6 cycles of Etoposide after diagnosis but a few months later was noted to have progressive metastatic disease including multiple soft tissue masses in the pelvis and abdomen with significant lymphadenopathy on CT imaging. At this time, PSA level was lower than when he was diagnosed at 45.9, although still elevated. Throughout the course of his disease the highest PSA level was 160.2, which was before his diagnosis of transformation to SCC. A lower PSA level than expected is a common characteristic of this disease process despite extensive local disease being seen on imaging for this patient. He was also found to have osseous metastasis in his lumbar spine and femur. SCC of the prostate is a rare entity affecting only 0.5-2% of men with prostate cancer. It is also one of the most aggressive malignancies. Chemotherapy is the standard treatment, but prognosis remains dismal for men with SCC of the prostate. He is planning to consider hospice with his palliative radiation as his disease has continued to cause him significant abdominal pain requiring emergency department visits and hospitalizations. Other options would include continuing his initial chemo regimen of Carboplatin/Etoposide vs. SALVAGE therapy for SCC.

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A Transformation of Prostate Adenocarcinoma to Small Cell Carcinoma