What are your treatment recommendations in a patient with de novo metastatic prostate adenocarcinoma with neuroendocrine differentiation?  

Neuroendocrine prostate cancer more often arises as a mechanism of treatment resistance than de novo, but in either case, portends aggressive disease biology and androgen insensitivity. Similar to the features of “aggressive-variant” prostate cancer described by Aparicio et al., PMID 265...