Case Series of Men with the Germline APC I1307K variant and Treatment-Emergent Neuroendocrine Prostate Cancer

Minas P. Economides, Mari Nakazawa, Jonathan W. Lee, Xiaochun Li, Lucas Hollifield, Rachelle Chambers, Michal Sarfaty, Judith D. Goldberg, Emmanuel S. Antonarakis, David R. Wise

Research output: Contribution to journalArticlepeer-review


Introduction: : Somatic mutations in the Wnt signaling gene Adenomatous Polyposis Coli (APC) promote metastatic prostate cancer (PCa) progression. Less is known regarding the impact of germline APC mutations on PCa outcomes. We sought to investigate the prevalence of aggressive variant PCa (AVPC) and treatment-emergent neuroendocrine PCa (t-NEPC) in patients with the germline APC I1307K variant, an alteration found in 7% of Ashkenazi Jewish men. Materials and Methods: We report a retrospective cohort study comparing patients with PCa and either APC I1307K germline mutation, APC somatic mutations, or unselected patients. Proportions of patients with AVPC among all the cases were estimated along with 95% Clopper-Pearson exact confidence intervals (CI). Odds ratios with 95% CI were provided for the prevalence of t-NEPC and AVPC in patients with germline APC I1307K compared to patients with frameshift alterations in APC. Results: From 2016-2022, 18 patients with PCa at 3 institutions with the germline APC (I1307K) mutation were identified. Clinically-defined AVPC was found in 8 of the 15 cases with metastatic disease (53%; 95% CI: 26%-79%). Combined somatic alterations in two or more of RB1, TP53 or PTEN (molecularly-defined AVPC) were found in 5/18 cases (28%; 95% CI: 10%-54%). When compared to 20 patients with APC somatic frameshift mutations, patients with the germline APC I1307K variant had a significantly increased risk of AVPC (OR 7.2; 95% CI 1.27, 40.68). Conclusion: PCa that develops in the presence of the germline APC I1307K mutation appear to be enriched for clinically-defined and molecularly-defined AVPC and in particular, for t-NEPC.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
D.R.W. is a paid consultant for Foundation Medicine, Pfizer, Janssen, Leap Therapeutics, Sanofi, Lilly, Labcorp, Myovant, Bayer. He has received travel funding from Pfizer and Bayer. E.S.A. Honoraria: Sanofi, Dendreon, Medivation, Janssen Biotech, ESSA, Astellas Pharma, Merck, AstraZeneca, Clovis Oncology, Amgen, Bayer, Blue Earth Diagnostics, Bristol Myers Squibb/Celgene, Celgene, Constellation Pharmaceuticals, Curium Pharma, Lilly, Exact Sciences, Foundation Medicine, GlaxoSmithKline, InVitae, ISMAR Health Care, Tempus, Orion, AIkido Pharma.

Publisher Copyright:
© 2023 Elsevier Inc.


  • APC
  • AVPC
  • NEPC
  • Prostate cancer

PubMed: MeSH publication types

  • Journal Article


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