Small-cell carcinomas of the prostate or high-grade prostate cancer with neuroendocrine differentiation are often lethal phenotypes with no direct pathognomonic symptoms. This article presents the case of a 52-year-old man diagnosed with high-grade prostate cancer and small-cell/neuroendocrine features who was managed with transurethral resection, androgen blockade, total pelvic exenteration, nephrostomy placement, and chemotherapy. The author highlights the treatment and management course in such patients and the need for early diagnosis of this aggressive type of tumor.
