Seeking Insights: Small Cell Carcinoma Prostate Recurrence with Adenocarcinoma Findings

[Andy2025]

My dad was previously diagnosed with small cell carcinoma and underwent treatment with platinum chemo and radiation. Six months post-treatment, his PET scan showed increased tumor activity in the prostate, lymph nodes, and lungs.

A needle biopsy of the prostate now revealed adenocarcinoma across all 12 cores. A subsequent PSMA PET scan showed faint low-grade uptake in the same areas, the FDG uptake was notably higher than the PSMA uptake, especially in the lymph nodes and lungs. Does this suggest the possibility of PSMA-negative components ( small cell)?

Interestingly, an MRI of the prostate didn’t show any suspicious lesions, aligning with the biopsy findings of low-grade adenocarcinoma. Given the recurrence pattern, I’m wondering if this strongly points to small-cell carcinoma of the prostate (SCCP) in the lymph nodes and lungs.

Considering the aggressive nature of SCCP, is it possible for it to metastasize to lymph nodes and distant sites even when the primary prostate tumor remains unaffected?

Our doctor is hesitant to initiate second-line chemo without more evidence and suggests trying abiraterone for one month. I’m curious about this approach—does it align with anyone else’s experience? Any insights or advice would be greatly appreciated!

[Tall_Allen]

Sadly, small cell is not something one can get rid of, and it does show up in FDG scans. It sounds like a mixed type so hormone therapy or docetaxel may suppress the adenocarcinoma part.

[larry_dammit]

wow that’s confusing. Is he seeing a oncologist I ll say a prayer for him

[j-o-h-n]

Only comment from me is that Keytruda worked on my lung metastases from my Melanoma on my neck.

Good Luck, Good Health and Good Humor.

j-o-h-n