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Life sciences · Journal article
Frontiers in Oncology · October 23, 2026
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Neuroendocrine prostate cancer (NEPC) is a rare, aggressive subtype with hormonal resistance and poor prognosis. Traditional serum biomarkers such as prostate-specific antigen (PSA) and neuron-specific enolase (NSE) are often present at low or normal levels, making it difficult to accurately reflect disease burden and progression, and thus renders them unsuitable for dynamically monitoring NEPC. We report a 64-year-old man with mixed neuroendocrine carcinoma and adenocarcinoma of the prostate, with bladder involvement. The adenocarcinoma component had a Gleason score of 5 + 4 = 9. Pretreatment 18 F‑FDG PET/CT showed uptake in prostatic and bladder lesions, while a sclerotic lesion at the sixth thoracic vertebra exhibited no FDG avidity. After chemotherapy, radiotherapy and long-term treatment with androgen deprivation therapy (ADT) in combination with bicalutamide, PSA levels became undetectable and NSE levels remained within the normal range with no significant change from baseline. However, follow‑up 68 Ga‑PSMA PET/MR revealed intense persistent uptake in the prostate and bladder and new avid lesions in the sixth thoracic vertebra and both scapulae. At the most recent follow-up, 68 Ga-PSMA PET/MR scan revealed decreased PSMA uptake in the prostate and bone lesions, as well as increased PSMA uptake in the bladder. A repeat bladder biopsy confirmed chronic inflammation rather than tumor progression. PSA and NSE levels remained largely unchanged during follow-up, while the clinical significance of the 68 Ga-PSMA PET findings required further assessment. This case demonstrates that the results of multi-tracer PET scans in patients with NEPC should be interpreted with caution and considered alongside the clinical course and biochemical markers. When necessary, a definitive diagnosis should be confirmed by histopathology.