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Metastatic prostate cancer (PCa) requires immediate attention in order to identify driving molecular mechanisms and therapeutic targets that will achieve sustainable regression of disease. Despite advances with novel therapies, patients either do not respond or develop rapid resistance to these agents (1). An emerging resistant phenotype is small-cell neuroendocrine prostate cancer or prostate adenocarcinoma with neuroendocrine features (NEPC) (2). The diagnosis of NEPC has clinical implications because these patients are often treated with platinum chemotherapy (3). Neuroendocrine differentiation in advanced PCa represents a significant therapeutic dilemma, and its prevalence may be underestimated at the present time because bone biopsies of metastatic sites are infrequent. In addition, the very definition of NEPC is subject to intense debate, in part because of the lack of objective criteria, ascribing an unequivocal molecular phenotype to this entity. Finally, the molecular mechanisms leading to and maintaining NEPC are not well understood. Benign and neoplastic stem cells share similar molecular programs and are functionally similar. Using lineage-tracing studies, Pignon et al. have previously shown that all cell types in the adult prostate, including neuroendocrine cells, derive from a common multipotent p63-expressing basal cell (4). These developmental studies and the current finding that metastatic small-cell neuroendocrine carcinoma is molecularly more stem-like than the more canonical adenocarcinoma, suggest either a de-differentiation of prostate cancer cells toward a more pluripotent (and neuroendocrine) phenotype or a selective therapeutic pressure for the expansion of existing rare tumor cells that are basal/stem/neuroendocrine from the start (4). The cell of origin of prostate cancer is still subject to debate. Although tissue regeneration experiments point to basal cells, genetically engineered mouse models, on the other hand, show that both basal and …

Advanced neuroendocrine prostate tumors regress to stemness