Prostate cancer stage 4 with bone metastasis now spreaded to liver

I know two people that have had neuroendocrine prostate cancer. They have passed. One of the major treatments that is done was chemotherapy with cabazitaxel with carboplatin included.

One person went to Austria and had actinium and Pluvicto treatments. Then came back and tried a PARP Inhibitor, but nothing worked.

For individuals with neuroendocrine prostate cancer (NEPC) that has metastasized to the liver, the median overall survival is typically around 10-14 months, according to a study published in the Journal of Clinical Oncology. This makes liver metastasis a particularly ominous site in metastatic castration-resistant prostate cancer (mCRPC).

If the neuroendocrine is not in the liver, then overall survival is usually less than 24 months.

There are studies being done for neuroendocrine cancer. You should definitely try to get into one of them. Here’s a list of the studies I know of

Neuroendocrine trials
From: MSKCC TargetDonc onclive ascopubs

There are several ongoing clinical studies targeting DLL3 in neuroendocrine prostate cancer (NEPC):
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Memorial Sloan Kettering Cancer Center (MSK) is opening a clinical trial testing a radioactive ligand that targets DLL3 in people with metastatic NEPC. Patients will first be screened for DLL3 expression and, if eligible, will receive the targeted therapy.
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The SKYBRIDGE trial (NCT05652686) is a phase 1/2 study evaluating peluntamig (PT217), which targets DLL3 and CD47, in patients with DLL3-expressing neuroendocrine carcinomas, including NEPC.
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A phase 1b study of tarlatamab, a DLL3-targeted bispecific T-cell engager, is ongoing in patients with metastatic NEPC, showing manageable safety and encouraging anti-tumor activity in DLL3-positive cases (NCT04702737).
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Other agents like HPN328, another DLL3-targeted T-cell engager, are also being tested in neuroendocrine prostate cancer.

These studies reflect a strong research focus on DLL3 as a therapeutic target for NEPC.
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Is it common for men treated with ADT drugs to develop Neuroendocrine prostate cancer when they originally had adenocarcinoma?

It is not common at all. There is a 10% chance of it happening after being on ADT or an ARI for more than four years.

In my dad's case it happened after taking enzalutamide for 15 months. If we would have picked different medication like abirateroen would have prevent it?
Also not sure if it is due to the treatment path we had Orchidactomy to start with and then chemo and enzalutamide.
Or combination of orchidactomy and enzalutamide.
Or instead of enzalutamide we would have gone for Lu 177 would have prevent it?

I encourage you to do a search of the Internet using this search

what causes prostate cancer to become neuroendocrine

Here are some information you would find

Neuroendocrine prostate cancer (NEPC) can arise from two main pathways: de novo, meaning it develops independently, or as a treatment-emergent form (t-NEPC) from pre-existing prostate adenocarcinoma. A key driver of t-NEPC is androgen deprivation therapy (ADT), which is used to treat prostate cancer by inhibiting the androgen receptor, leading to the cancer cells developing resistance and transforming into NEPC.

The purpose of ADT is to reduce the amount of testosterone, The surgery did the same thing, Though testosterone does get created other places in the body. Zytiga takes it a step further and reduces testosterone even more. Does that mean that it is more likely to cause neuroendocrine than Enzalutamide, I can’t say, but since it acts more like an ADT Then maybe it is not a better solution to move to Zytiga.

I’m not sure anybody has a real answer to this question.

Thank you jeff. I am also doing this research and finding my answers. There other patient who is 10 years younger then my dad. Probably 57 years old his gleason score was 9. He has started his treatment journey by taking testosterone ruduction injection every 3 months and then started zytiga for few months and then change to enzalutamide and he has been taking enzalutamide for 2 years now. He is so far doing good.
Only different thing he has done from us is not doing Orchidactomy instead 3 monthly injections and haven't gone on a chemo path.

Adding a second ADT medicine is thought to increase the chance of this. Or the second medicine can help with treatment. Unfortunately I don’t believe they know how it will go for any individual.

This is one of the big frustrations in prostate cancer. No, two people have the same issues with their cancer. There are wide ranging differences, even with people that seem to have very similar cases.

Did enz, 2 chemos Ra 233 then Abiraterone All failed over years

Awaiting LU 177 soon with God's help as I meet all criteria
https://www.novartis.com/news/media-releases/novartis-pluvictotm-demonstrates-statistically-significant-and-clinically-meaningful-rpfs-benefit-patients-psma-positive-metastatic-hormone-sensitive-prostate-cancer?utm_source=twitter&utm_medium=social&utm_campaign=PSMAAdditionPR2025&utm_content=static-image-news

Anyone of the doctors mentioned liver resection? I remember a patient from my father's "abiraterone group" who underwent liver resection after CT showed 2 mets , but one was too big for SyberKnife (or too close to the colon, i can't remember now) and from what I've heard he is doing just fine! Also SyberKnife is also an option. Ask the doctors. And don't give up!