Salvage Re-transurethral Resection of Prostate as a Diagnostic and Therapeutic Bridge in Treatment-Emergent Neuroendocrine Prostate Cancer: A Multimodal Management Paradigm

Neuroendocrine differentiation of prostatic adenocarcinoma is a very rare and extremely aggressive variant that usually develops after long-term androgen deprivation therapies. Because of the unique biology and rapid progression, early detection of the variant is essential for prompt treatment. We present the case of a male patient in his early 60s who initially underwent transurethral resection of the prostate and bilateral orchidectomy for high-grade metastatic prostatic adenocarcinoma (Gleason 4 + 4, prostate-specific antigen: 44 ng/mL) and had two years of clinical stability. Imaging revealed prostate-specific membrane antigen-avid pelvic lymph nodes and bony metastases, and he subsequently experienced multiple episodes of urinary retention and hematuria. Repeat transurethral resection of the prostate revealed neuroendocrine transformation due to atypical castrate-resistant progression. Systemic chemotherapy and repeated cystoscopies with fulgurations were used to treat our patient, which improved voiding, stabilized the systemic disease, and resolved hematuria. This case highlights the quick evolution of neuroendocrine carcinoma after hormonal therapy and emphasizes that multimodal, individualized treatment can offer meaningful symptom relief and disease control for the patient despite its poor prognosis.