Basal cell carcinoma of the prostate: a case report responding to the FGFR inhibitor pemigatinib and literature review

Abstract

Purpose of reviewDue to the limited number of cases, there are no guidelines for basal cell carcinoma (BCC) of the prostate. This review combines an unpublished case report of a 55-year-old patient with BCC with an assessment of the latest literature.Recent findingsBCC of the prostate has previously been described in only approximately 140 cases. We describe the diagnostic process, including the uropathological and DNA-sequencing results, which allowed us to start an experimental treatment with pemigatinib. BCC of the prostate is associated with an aggressive biological and clinical behavior, such as recurrence and metastasis. Several immunohistochemical stainings are available to differentiate BCC from adenocarcinoma of the prostate. Based on pathology and results from next-generation sequencing (NGS), patients can be offered targeted therapies.SummaryWith the aid of histological work-up and immunostaining, prostatic BCC can be accurately diagnosed. Our patient underwent radical prostatectomy and staged extended lymphadenectomy due to lymph node recurrence. The patient subsequently developed progressive disease and was treated with the FGFR-inhibitor pemigatinib. The patient's liver metastasis significantly responded. The present case confirms the possibility of aggressive behavior of prostatic BCC and highlights the importance of a thorough uropathological and molecular biological analysis with a precision medicine strategy.

Basal cell carcinoma of the prostate with squamous metaplasia: A case report and literature review

“…BCCP is a very rare form of cancer that accounts for 0.01% of prostate cancers ( 7 ). The first case of BCCP was reported in 1974, and the total cumulativenumber of reported cases till date is about 140 ( 8 , 9 ). BCCP is usually considered to be insidious, but there are many reported cases of recurrence and metastasis ( 4 , 10 ).…”

“…Based on the current knowledge on BCCP, its age of onset is between 28 to 97 years old, with the highest prevalence in 60 to 75 years age group ( 6 ). Approximately 89% of patients with BCCP initially present with predominantly obstructive lower urinary tract symptoms, while others present with hematuria ( 8 ). The serum PSA levels are usually within normal limits, which results in its misdiagnosis as prostatic hyperplasia ( 12 ).…”

“…The serum PSA levels are usually within normal limits, which results in its misdiagnosis as prostatic hyperplasia ( 12 ). Its diagnosis is often confirmed by histopathological examination after transurethral resection of the prostate ( 8 ). It is commonly reported that, grossly, BCCP is yellow in color with a hard consistency ( 6 ).…”

“…P63 and 34βE12 markers are highly specific and sensitive for basal cell carcinoma of the prostate, and the diagnostic value is improved when these tests are performed together ( 13 ). Other markers such as CD44 and P53 may also be useful in the diagnosis of prostate basal cell carcinoma, but the results are inconsistent ( 8 ). The strong expression of Bcl-2 and increased Ki-67, which are associated with the grade of malignant tumors, help to distinguish it from benign basal cell hyperplasia ( 8 , 12 ).…”

“…Other markers such as CD44 and P53 may also be useful in the diagnosis of prostate basal cell carcinoma, but the results are inconsistent ( 8 ). The strong expression of Bcl-2 and increased Ki-67, which are associated with the grade of malignant tumors, help to distinguish it from benign basal cell hyperplasia ( 8 , 12 ). There is typically no PSA or PAP immunostaining in BCCP ( 8 ).…”