{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:07:54Z","timestamp":1771286874453,"version":"3.50.1"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aktuelle Urol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Das therapieassoziierte neuroendokrine Prostatakarzinom (tNEPC) ist eine seltene, prognostisch ung\u00fcnstige Verlaufsform des kastrationsresistenten Prostatakarzinoms, die typischerweise unter Androgendeprivation oder Androgenrezeptor-Signalweginhibition entsteht. Der zugrunde liegende Prozess der Transdifferenzierung wird durch genetische Alterationen (TP53-, RB1- und PTEN-Verlust), epigenetische Reprogrammierung sowie das Tumormikromilieu beg\u00fcnstigt. Klinisch zeigen tNEPCs ein aggressives Verhalten, viszerale und osteolytische Metastasen, eine h\u00e4ufig geringe PSA-Expression sowie PSMA-negative\/ niedrig exprimierende L\u00e4sionen im PSMA-PET-CT. Die aktualisierte S3-Leitlinie empfiehlt eine Rebiopsie bei entsprechender Konstellation. Histologisch werden das kleinzellige neuroendokrine Karzinom (SCNEC), das gro\u00dfzellige neuroendokrine Karzinom (LCNEC) sowie gemischte Tumoren (MiNEN) mit neuroendokrinen und adenokarzinomat\u00f6sen Anteilen unterschieden. In der 5. Edition hat die WHO erstmalig das tNEPC als eigenst\u00e4ndige Entit\u00e4t anerkannt. Die immunhistochemische Diagnose st\u00fctzt sich dabei auf Marker wie Synaptophysin, Chromogranin A, CD56 und INSM1. Neben der Histologie sind [\u00b9\u2078F]-FDG- und DOTA-basierte PET\/CT-Verfahren sowie zunehmend Liquid-Biopsy-Ans\u00e4tze (zirkulierende Tumorzellen, cfDNA-Methylierung) f\u00fcr Diagnostik und Verlaufskontrolle relevant. Therapeutisch stellt die platinbasierte Chemotherapie derzeit den Standard dar. Neue Therapiestrategien richten sich gegen molekulare Zielstrukturen wie AURKA, EZH2 oder DLL3. In Einzelf\u00e4llen kann bei positiver Somatostatinrezeptor-Expression eine Peptidrezeptor-Radionuklidtherapie erwogen werden. Aufgrund der biologischen Heterogenit\u00e4t und limitierten Evidenzlage erfordert das tNEPC ein individualisiertes und interdisziplin\u00e4res Management. Dieser \u00dcbersichtsartikel fasst aktuelle Erkenntnisse zu Pathogenese, Diagnostik und Therapieoptionen zusammen und gibt einen Ausblick auf zuk\u00fcnftige Entwicklungen.<\/jats:p>","DOI":"10.1055\/a-2768-8830","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:10:59Z","timestamp":1769127059000},"page":"78-87","source":"Crossref","is-referenced-by-count":0,"title":["Therapieinduziertes neuroendokrines Prostatakarzinom (tNEPC) \u2013 Eine Herausforderung in der Uro-Onkologie: Diagnostik, klinische Relevanz und therapeutische Perspektiven"],"prefix":"10.1055","volume":"57","author":[{"given":"Gunhild","family":"von Amsberg","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf","department":["Onkologisches Zentrum\/Martini-Klinik"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arndt","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum 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Aggarwal","year":"2018","journal-title":"J Clin Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s13046-022-02255-y","article-title":"Aggressive variants of prostate cancer: underlying mechanisms of neuroendocrine transdifferentiation","volume":"41","author":"L Merkens","year":"2022","journal-title":"J Exp Clin Cancer Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1158\/1078-0432.CCR-15-1259","article-title":"Combined Tumor Suppressor Defects Characterize Clinically Defined Aggressive Variant Prostate Cancers","volume":"22","author":"AM Aparicio","year":"2016","journal-title":"Clin Cancer Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s11912-020-01003-9","article-title":"Clinical and Biological Features of Neuroendocrine Prostate Cancer","volume":"23","author":"Y Yamada","year":"2021","journal-title":"Curr Oncol 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