Resistance to androgen receptor signaling inhibition does not necessitate development of neuroendocrine prostate cancer

JCI Insight. 2021 Apr 22;6(8):e146827. doi: 10.1172/jci.insight.146827.


Resistance to AR signaling inhibitors (ARSis) in a subset of metastatic castration-resistant prostate cancers (mCRPCs) occurs with the emergence of AR- neuroendocrine prostate cancer (NEPC) coupled with mutations/deletions in PTEN, TP53, and RB1 and the overexpression of DNMTs, EZH2, and/or SOX2. To resolve whether the lack of AR is the driving factor for the emergence of the NE phenotype, molecular, cell, and tumor biology analyses were performed on 23 xenografts derived from patients with PC, recapitulating the full spectrum of genetic alterations proposed to drive NE differentiation. Additionally, phenotypic response to CRISPR/Cas9-mediated AR KO in AR+ CRPC cells was evaluated. These analyses document that (a) ARSi-resistant NEPC developed without androgen deprivation treatment; (b) ARS in ARSi-resistant AR+/NE+ double-positive "amphicrine" mCRPCs did not suppress NE differentiation; (c) the lack of AR expression did not necessitate acquiring a NE phenotype, despite concomitant mutations/deletions in PTEN and TP53, and the loss of RB1 but occurred via emergence of an AR-/NE- double-negative PC (DNPC); (d) despite DNPC cells having homogeneous genetic driver mutations, they were phenotypically heterogeneous, expressing basal lineage markers alone or in combination with luminal lineage markers; and (e) AR loss was associated with AR promoter hypermethylation in NEPCs but not in DNPCs.

Keywords: Oncology; Prostate cancer.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Abiraterone Acetate / therapeutic use
  • Animals
  • Antineoplastic Agents / therapeutic use
  • Benzamides / therapeutic use
  • Carcinoma, Neuroendocrine / genetics*
  • Carcinoma, Neuroendocrine / metabolism
  • Cell Transformation, Neoplastic / genetics*
  • Drug Resistance, Neoplasm / genetics*
  • Enhancer of Zeste Homolog 2 Protein / genetics
  • Male
  • Mice
  • Neoplasm Transplantation
  • Nitriles / therapeutic use
  • PTEN Phosphohydrolase / genetics
  • Phenylthiohydantoin / therapeutic use
  • Prostatic Neoplasms, Castration-Resistant / drug therapy
  • Prostatic Neoplasms, Castration-Resistant / genetics*
  • Prostatic Neoplasms, Castration-Resistant / metabolism
  • Receptors, Androgen / genetics
  • Retinoblastoma Binding Proteins / genetics
  • SOXB1 Transcription Factors / genetics
  • Thiohydantoins / therapeutic use
  • Tumor Suppressor Protein p53 / genetics
  • Ubiquitin-Protein Ligases / genetics


  • AR protein, human
  • Antineoplastic Agents
  • Benzamides
  • Nitriles
  • RB1 protein, human
  • Receptors, Androgen
  • Retinoblastoma Binding Proteins
  • SOX2 protein, human
  • SOXB1 Transcription Factors
  • TP53 protein, human
  • Thiohydantoins
  • Tumor Suppressor Protein p53
  • apalutamide
  • Phenylthiohydantoin
  • enzalutamide
  • EZH2 protein, human
  • Enhancer of Zeste Homolog 2 Protein
  • Ubiquitin-Protein Ligases
  • PTEN Phosphohydrolase
  • PTEN protein, human
  • Abiraterone Acetate