Update- My hubby Mike (age 46) just had a tumor removed from his neck last Monday. Pathology revealed the following...
Poorly differentiated carcinoma, focal possible glandular differentiation. Diffusely positive for Synaptophysin and chromogranin with weak expression of NKX3.1. It also states that the current tumor does not show any definitive morphologic or immunopheotypic evidence of glandular or prostatic differentiation but is noted to have more pronounced neuroendocrine differentiation when compared to the original tumor. Mike’s original biopsy showed the same neuroendocrine markers but they were rare when compared to the prostate cells. Questions...
This appears to have morphed into a neuroendocrine cancer. They were not able to remove all of the tumor so radiation seems likely. What else can we expect? Platinum based chemo? Is there anyone else with a similar presentation? Mike started with a PSA of 718 and extensive mets to bones and lymph nodes. He is taking casodex with lupron and completed 6 rounds of taxotere. PSA dropped to .14 now at .28.
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Bird8
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It sounds like a mixture of acinar adenocarcinoma and neuroendocrine. They usually give docetaxel + carboplatin. Here are some clinical trials that may be beneficial:
Thank you TA! I appreciate you taking the time to reply, your knowledge has provided clarity during this difficult time. They removed a 9cm mass on August 19th that was originally 5cm in May. The MO only supported surgery if they were able to remove 100% of the tumor. Based on scans and earlier appts they felt confident that they could. Well, now we have a very aggressive NECP left behind. Hubby still healing from surgery but it appears they want to radiate the remaining mass then follow with carbo/cabazitaxel or carbo/docetaxel. Do you feel this would be a good approach to start. Fearful that we let the monster out of the cage with surgery but the tumor burden was too great.
I don't know if radiation will work on neuroendocrine tumors - they are usually impervious to radiation. But if it's a mixed type, it may destroy some of it. Did the tumor express somatostatin or PD-L1? (probably not). Look at those clinical trials and discuss them with his oncologist.
Also, consider a consult with Misha Beltran at Dana Farber - she's working on some drugs targeted at specific rare PC variants.
I will be looking into the trials you mentioned and Dr. Beltran’s research is highly regarded. A second opinion seems warranted at this point. Mike was 44 when he was dx (2 yrs ago) PSA 718 extensive mets to bones and lymph nodes. He started on taxotere with casodex and lupron. PSA dropped down to .14. He was dx from a tumor in the neck (same spot as the current tumor). The original tumor showed neuroendocrine markers (synaptophysin and chromogranin) but they were rare in comparison to the prostate cells. The original tumor was sequenced and was negative for PD-L1 expression. He carries the BRCA2 gene (lynparza was mentioned as a tx option). We will have the new tumor sequenced as I’m sure much has changed. He is receiving care through the Cleveland Clinic Taussig center.
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Slowly Rising PSA
Changing from Adenocarcinoma to small cells or Neuroendocrine?
Neuroendocrine cancer % in APC patients is not rare, it’s becoming common. 
