case_images: PMC11410569_01
case_images: HE staining results and MRI scans of patient A. (A1) The tumor exhibits infiltrative growth. Focally, there are poorly differentiated glandular structures characterized by significant nuclear atypia. The cells are arranged in solid nests or cords. (HE staining, x100). (A2) The tumor cells show significant nuclear atypia, with some cells appearing spindle-shaped. There is a diffuse arrangement of cells accompanied by necrosis. (HE staining, x100). (B1) Prostate MRI showed reveals an enlarged prostate gland with an irregularly shaped, heterogeneous soft tissue mass in the prostate region (Red arrow). (B2) Prostate MRI shows tumor invasion of the rectum (Red oval). HE, hematoxylin and eosin. MRI, magnetic resonance imaging.
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case_images: A needle core biopsy of the gland was performed, obtaining twelve cores, two of which showed high-grade adenocarcinoma involving less than 50% of the total length, with a Grade Group 5: Gleason score of 9 (5 + 4) ( Figure 1 ). PSA at 1.030 ng/ml, free PSA at 0.130 ng/ml, and testosterone at 9.18 ng/dl. Prostate MRI ( Figure 1 ) showed an enlarged prostate with an irregular shape, with an irregular mass on the right side measuring approximately 113mmx82mm. Pathological examination ( Figure 1 ) revealed that the cells exhibit marked pleomorphism, including spindle and polygonal cells.
case_images: Treatment Course and Follow-up Results of Patient A. The green dashed line represents the endocrine therapy phase, while the blue dashed line represents the non-endocrine therapy phase.
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case_images: The results during the follow-up period, as shown in  Figure 2 , indicated that PSA levels remained within the normal range. The patient's treatment history and main test results are shown in  Figure 2 .
case_images: Immunohistochemistry (magnification, x100) and E-Cadherin Immunofluorescence Results (magnification, x200) for Patient A. (A) CK (+), only a few cancer cells are positive. (B) Vimentin (+), (C) AR (+), and (D) NES (+). (E) Compared to the cells on the right side of the green dashed line, the cancer cells on the left show a significant reduction in E-cadherin expression. (F) The negative control for E-Cadherin immunofluorescence. (+): Positive. (-): Negative.
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case_images: Immunohistochemical staining ( Figure 3 ) showed the following: P504s (-), PSA (-), Vimentin (+), P40 (-), P63 (-), CK7 (-), CK20 (-), CD34 (-), PR (-), CK (partially +), AR (+), and NES (+). Transition (EMT), we performed immunofluorescent staining for E-cadherin on the resected tissue from this patient. The results showed a reduction in E-cadherin expression in some cancer cells, as seen in  Figure 3 .
case_images: PMC11410569_02
case_images: Imaging and pathological examination results for Patient B. (A1-A2) MRI of the prostate shows an enlarged gland, especially in the central zone. Bone destruction is observed in both acetabula, the right femoral head, and the sacrum, indicating prostate cancer with multiple bone metastases. Red arrows denote the tumor, and red ovals highlight the bone metastases. (B1) Whole-body bone scans from September 2019 (at initial presentation) and (B2) May 2023 (post-endocrine therapy). (C1) The pathological HE staining from September 2019 shows diffusely arranged spindle-shaped tumor cells with infiltrative growth, significant nuclear atypia, and no apparent glandular structures (magnification, x100). (C2) The pathological HE staining from September 2019 shows tumor cells exhibit diverse morphologies, including spindle-shaped and stellate forms, among others. The cells demonstrate a disordered arrangement, lacking clear organizational structure, and display pronounced stromal characteristics. The cells exhibit invasive growth patterns and are accompanied by necrosis (magnification, x100).
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case_images: PSA was above 50 ng/ml. Prostate MRI ( Figure 4 ) showed an enlarged prostate with homogenous signal on T1-weighted images and heterogeneously slightly high signal on T2-weighted images, with uneven high signal on diffusion-weighted imaging (DWI); bone destruction was observed in both acetabula and the right femoral head, with low signal on T1 and high signal on fat-suppressed T2-weighted images, suggesting prostate cancer with multiple bone metastases. Whole-body bone scan ( Figure 4 ) also indicated multiple bone metastases from prostate cancer. A prostate needle core biopsy was performed, obtaining twelve cores, all of which showed high-grade adenocarcinoma involving more than 50% of the total length, with a Grade Group 4: Gleason score of 8 (4 + 4) ( Figure 4 ). Whole-body bone scintigraphy ( Figure 4 ) showed intense nucleotide distribution in multiple areas including bilateral clavicles, parts of the thoracic vertebrae, parts of bilateral ribs, multiple areas of the pelvis, and the upper segment of the right femur, suggesting widespread bone metastases. Pathological examination ( Figure 4 ) showed the cells exhibit considerable variability in size and shape, including spindle and polygonal cells.
case_images: Treatment Course and Follow-up Results of Patient B.
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case_images: All PSA results during the follow-up are shown in  Figure 5  and remained within normal ranges.
case_images: Immunohistochemistry (magnification, x100) and E-Cadherin Immunofluorescence Results (magnification, x200) for Patient B. (A) CK (+), only a few cancer cells are positive. (B) Vimentin (+), (C) AR (-), and (D) NES (+). (E) Compared to the cells in other areas, the cancer cells within the green ellipse exhibit a significant reduction in E-cadherin expression. (F) The negative control for E-Cadherin immunofluorescence. (+): Positive. (-): Negative.
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case_images: The results showed a reduction in E-cadherin expression in some cancer cells, as seen in  Figure 6 .