De novo small cell neuroendocrine prostate cancer: An atypical case presentation

Small cell neuroendocrine carcinoma comprises less than 1 % of all prostate cancers. We report a case of a 62-year-old male who presented acutely with severe lower urinary tract symptoms (LUTS), including nocturia, but with normal prostate-specific antigen (PSA) levels. A tender, stony-hard prostate on digital rectal examination (DRE) led to prostate biopsy and imaging. The biopsy confirmed neuroendocrine carcinoma, and chemotherapy was initiated. This case emphasizes the atypical presentation of neuroendocrine prostate cancer with acute, severe LUTS and rapid progression, underscoring the potential for missed diagnoses when PSA levels are normal.