Review Article | Published:

Paraneoplastic syndromes in prostate cancer

Nature Reviews Urology volume 7, pages 681692 (2010) | Download Citation

Abstract

Prostate cancer is the second most common urological malignancy to be associated with paraneoplastic syndromes after renal cell carcinoma. These syndromes tend to occur in the setting of late stage and aggressive tumors with poor overall outcomes. Recognition of these syndromes is clinically important as it might lead to the detection of underlying malignancy and impact on the treatment options available. The literature features around 100 cases of paraneoplastic syndromes associated with prostate cancer and these include endocrine manifestations, neurological entities, dermatological conditions, and other syndromes. Over 70% of cases document the syndrome as the initial clinical manifestation of prostate cancer, while in just under 20% the syndrome was an initial sign of disease progression to the castrate-resistant state. The vast majority of cases involved advanced metastatic malignancy. The syndromes generally resolve upon institution of treatment for the underlying prostate cancer, but some syndromes require specific therapies. Some syndromes are associated with serum markers that are readily detectable and demonstration of these putative markers within prostate cancer tissue at an individual level would firmly link the paraneoplastic syndrome with its underlying prostatic malignancy. The causes of paraneoplastic syndromes in prostate cancer are incompletely understood, and further research into their biology might shed more light on the complex molecular mechanisms that underpin prostate cancer and its lethal potential.

Key points

  • Prostate cancer is the second most common urological malignancy (after renal cell carcinoma) to be associated with paraneoplastic syndromes

  • Prostate cancer associated with a paraneoplastic syndrome tends to be metastatic and follow an aggressive course

  • Paraneoplastic syndromes might be the initial presenting manifestation of occult prostate cancer or might represent the first signs of progression to castrate-resistant disease

  • Histology of prostate cancer associated with a paraneoplastic syndrome frequently reveals neuroendocrine features or small cell carcinoma

  • Demonstration within prostate tissue of the putative marker responsible for the paraneoplastic syndrome strongly supports a diagnosis

  • Symptoms of paraneoplastic syndromes usually resolve with treatment of the underlying malignancy although initial symptomatic therapy might be required

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Acknowledgements

M. Hong is supported by scholarships from the Royal Australasian College of Surgeons and the National Health and Medical Research Council (Australia). Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Affiliations

  1. Division of Urology, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, Vic 3050, Australia

    • Matthew K. Hong
    • , Benjamin Namdarian
    •  & Anthony J. Costello
  2.  Department of Surgery, Central Clinical School, Monash University, Commercial Road, Melbourne, Vic 3004, Australia

    • Jennifer Kong
  3.  Department of Pathology, The Alfred Hospital, Commercial Road, Melbourne, Vic 3181, Australia

    • Anthony Longano
  4.  Department of Urology, The Alfred Hospital, Commercial Road, Melbourne, Vic 3181, Australia

    • Jeremy Grummet
  5.  Australian Prostate Cancer Research Centre at Epworth Hospital, Level 2, 185 Hoddle Street, Richmond, Melbourne, Vic 3121, Australia

    • Christopher M. Hovens
    •  & Niall M. Corcoran

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Contributions

M. K. Hong and J. Kong contributed equally to the research, discussion, writing and editing of this manuscript. B. Namdarian contributed to the research and discussion of the paper. A. Longano was involved in researching data for the article and reviewing the manuscript before submission. J. Grummet made a substantial contribution to the discussion of content. C. M. Hovens, A. J. Costello and N. M. Corcoran were involved in the discussion of content and reviewing the manuscript before submission.

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The authors declare no competing financial interests.

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Correspondence to Matthew K. Hong.

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DOI

https://doi.org/10.1038/nrurol.2010.186

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