Unexpected Response to Hormonal Therapy in Metastatic Neuroendocrine-Differentiated Prostate Adenocarcinoma: A Case Report.

Prostate cancer with neuroendocrine differentiation (NEPC) is an aggressive subtype typically considered androgen-indifferent and primarily managed with chemotherapy. Presentation as a hepatic visceral crisis constitutes a medical emergency with high mortality, often requiring urgent systemic chemotherapy. We report the case of a 52-year-old male patient who presented with life-threatening hepatic visceral crisis as the initial manifestation of metastatic neuroendocrine differentiated prostate adenocarcinoma, Gleason score 9 (4 + 5), with a prostate-specific antigen (PSA) level of 137 ng/mL. Remarkably, first-line androgen deprivation therapy (ADT) as monotherapy led to rapid and marked clinical improvement, with complete normalization of liver function tests within one month, prior to any chemotherapy. The patient subsequently underwent consolidation chemotherapy and remains in complete and durable remission, with an undetectable PSA level. This case illustrates that significant sensitivity to ADT can persist even in the context of aggressive prostate cancer with neuroendocrine features and acute organ dysfunction. It challenges the routine exclusion of hormonal therapy in such scenarios and highlights the potential of ADT as a life-saving therapeutic bridge in critical clinical settings.