[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-433559-105":59,"doc-detail-433559-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","genomic-insights-for-neuroendocrine-prostate-cancer-editorial","Genomic insights for neuroendocrine prostate cancer - Editorial","","Editorial discussion on genomic insights for neuroendocrine prostate cancer (NEPC) within the broader context of prostate cancer progression from androgen-deprivation therapy. It reviews how androgen receptor–driven biology supports initial responses yet many patients develop castration-resistant disease. The piece highlights the rarity and aggressive uncertainty of NEPC, then evaluates recent metastatic NEPC experience by Lai et al, raising questions about p-NEPC versus t-NEPC incidence, diagnostic evidence, neuroendocrine component proportion, and treatment decisions such as timing of ADT and chemotherapy regimen selection.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/genomic-insights-for-neuroendocrine-prostate-cancer-editorial/433559/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/genomic-insights-for-neuroendocrine-prostate-cancer-editorial/433559.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is neuroendocrine prostate cancer difficult to manage?","Question",{"text":112,"@type":113},"NEPC has unique biological and molecular characteristics and an extremely rare incidence, creating uncertainty about optimal management strategies and contributing to unpredictable clinical courses.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What issues are raised regarding p-NEPC and t-NEPC in Lai et al’s report?",{"text":117,"@type":113},"The editorial questions whether the incidence of treatment-emergent NEPC (t-NEPC) was underestimated or whether primary/de novo NEPC (p-NEPC) was overestimated, given the reported proportions.",{"name":119,"@type":110,"acceptedAnswer":120},"What diagnostic and treatment concerns are highlighted?",{"text":121,"@type":113},"Concerns include whether AR and PSMA expression were sufficiently reduced or absent to support p-NEPC diagnosis, what percentage of neuroendocrine component existed in original specimens, and why patients with elevated PSA did not receive simultaneous ADT, as well as which chemotherapy regimen is best.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},433559,1790824368,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","J Chin MedAssoc  \nEditorial  \nGenomic insights for neuroendocrine prostate cancer  \nPeng-Hui Wanga,b,c,*, Szu-Ting Yanga,b, Chia-Hao Liua,b  \naDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC  \nProstate cancer (PC) is the second most common male cancers, with the fifth cause of cancer-related deaths among men in the world.1–3 PC is recognized as a hormone-dependent cancer, and androgen and androgen receptor (A-AR) pathway plays a pivotal role in the pathogenesis and progression of PC mediated by controlling the cellular programs and subsequently promoting PC cell proliferation, survival, and dissemination.4,5 Based on the aforementioned findings, utilization of androgen deprivation therapy (ADT) is in long-term considered as the cornerstone of treatment for PC patients for decades, because ADT not only significantly improves both progression-free survival (PFS) and overall survival (OS) rates, but also offers a relatively high quality of life (QoL) of the treated patients, because of escaping from the more toxic effects of systemic cytotoxic agents, such as the conventional multi-agent chemotherapy.4,5 However, even though the initial response and control rates of ADT are relatively promising and exciting, the majority of PC patients finally develop the castration-resistant disease status after a median of 16 to 18 months, which results in a big challenge for both physicians and patients.4–6 In recent years, advanced development and wide introduction of new agents, such as the novel hormonal agents, chemotherapeutic regimens, and immunotherapy (immune checkpoint inhibitors [ICIs] as an example) as well as targeted therapy have led to outcome improvement in the castration-resistant PC (CRPC) patients; unfortunately, a small proportion of the CRPC patients may have an unusual more aggressive clinical courses that are resistant to the conventional and advanced therapeutic approaches, resulting in subsequent therapeutic failure and cancer-related mortality. One of the particular CRPC histological cell types, known as neuroendocrine PC (NEPC), which is either derived from the presence of neuroendocrine components at the time of diagnosis (p-NEPC) or secondary to treatment emergent NEPC (t-NEPC) is a typical example, since NEPC has unique biological and molecular characteristics and the incidence of NEPC is extremely rare. All contribute to uncertainty of optimal management strategies for treating NEPC patients. Based on the aforementioned reasons,  \n*Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail addresses: phwang@vghtpe.gov.tw](ROC. E-mail addresses: phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang).  \nConflicts of interest: Dr. Peng-Hui Wang, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2025) 88: 583-584.  \nReceived June 3, 2025; accepted June 4, 2025. doi: 10. 1097/JCMA.0000000000001255  \nCopyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nany breakthrough in management of this unusual disease is welcome.  \nRecently, Lai et al’s7 group attempted to present their realworld experience in treatment outcome and genomic insights for metastatic NEPC. Consistent with the literature review,4–6 Lai et al’s7 d","cbCaioRvquG9p367","https://ap.wps.com/l/cbCaioRvquG9p367","pdf",267863,"English","# Editorial\n## Clinical context: castration-resistant prostate cancer and NEPC\n## Review of Lai et al’s metastatic NEPC findings\n## Key unresolved issues: classification, diagnosis, biomarkers, and therapy","[{\"question\":\"Why is neuroendocrine prostate cancer difficult to manage?\",\"answer\":\"NEPC has unique biological and molecular characteristics and an extremely rare incidence, creating uncertainty about optimal management strategies and contributing to unpredictable clinical courses.\"},{\"question\":\"What issues are raised regarding p-NEPC and t-NEPC in Lai et al’s report?\",\"answer\":\"The editorial questions whether the incidence of treatment-emergent NEPC (t-NEPC) was underestimated or whether primary/de novo NEPC (p-NEPC) was overestimated, given the reported proportions.\"},{\"question\":\"What diagnostic and treatment concerns are highlighted?\",\"answer\":\"Concerns include whether AR and PSMA expression were sufficiently reduced or absent to support p-NEPC diagnosis, what percentage of neuroendocrine component existed in original specimens, and why patients with elevated PSA did not receive simultaneous ADT, as well as which chemotherapy regimen is best.\"}]","Genomic insights for neuroendocrine prostate cancer - Editorial | PDF",1790664591]