Despite improved overall survival, an unintended consequence of ARPI therapy is selective pressure that results in an increase in treatment-related neuroendocrine prostate cancer (NEPC) from prostate adenocarcinoma (PRAD), a lineage transition resembling EGFR-mutant lung adenocarcinomas that transition to small cell lung cancer (SCLC) following treatment with EGFR inhibitors (6, 7). Here, EGFR is linked to small cell lung carcinoma.