Prostatic adenocarcinoma combined with squamous cell carcinoma:A case report and literature review

ZHOU Hengfeng; LIU Jinhui; ZHU Yuanting; LUO Sheng; WANG Shuo; ZHOU Benzheng

doi:10.13263/j.cnki.nja.2026.01.007

Abstract：Objective The aim of this study is to investigate the clinical characteristics,diagnostic challenges and treat-ment strategies for prostatic acinar adenocarcinoma combined with squamous cell carcinoma(SASC),which provides the refer-ence for clinical decision-making.Methods The clinical history,imaging findings and pathological features of an 82-year-old male with prostatic adenosquamous carcinoma(ASC)were introduced in this article.A systematic literature review was conduc-ted using the CNKI and PubMed databases to summarize pathological mechanisms,diagnostic criteria,and therapeutic approa-ches for ASC.Results The patient initially presented with an elevated prostate-specific antigen(PSA)level and declined a di-agnostic prostate biopsy at the first visit.Following endocrine therapy,PSA decreased to castration levels.Due to persistent low-er urinary tract symptoms,the patient re-presented and was subsequently diagnosed with prostatic adenosquamous carcinoma via biopsy.Immunohistochemistry showed the coexistence of squamous cell carcinoma markers(CK5/6,p63,p40 positive)and ad-enocarcinoma markers(NKX3.1).As the family declined radical prostatectomy,ongoing endocrine therapy was combined with local radiotherapy for disease control.Ultimately,due to disease progression accompanied by hematuria and severe urinary ob-struction,the patient underwent palliative transurethral resection of the prostate and cystoscopy,during which a bladder perfora-tion was identified.Literature analysis indicates that prostatic ASC is rare,with aggressive squamous components resistant to en-docrine therapy and a median survival of 11 months.Early radical surgery combined with chemoradiotherapy may improve prog-nosis,but most patients with advanced-stages disease require palliative interventions(transurethral resection,prostatic artery embolization).Conclusion Prostatic ASC exhibits dual adenocarcinoma-squamous differentiation,necessitating extensive path-ological sampling and immunohistochemical differentiation to avoid misdiagnosis.Personalized comprehensive strategies were re-quired for its poor prognosis,which includes radical surgery with adjuvant therapy for early-stage disease and symptom-focused palliation(e.g.,platinum-based chemotherapy,targeted therapies)for advanced cases,though evidence remains limited.Mul-ticenter studies are urgently needed to optimize diagnostic and therapeutic protocols.