Prostate cancer, Hu antibodies and paraneoplastic neurological syndromes

Abstract

Prostate cancer is the most common cancer among American and European men. Nervous system affection caused by local tumor growth or osseous metastases are the main causes of neurological symptoms in prostate cancer patients. Prostate cancer is rarely reported in association with paraneoplastic neurological syndromes (PNS). We have, therefore, studied clinical and paraclinical findings of a series of patients with prostate cancer and PNS, and reviewed cases reported in the literature. Case histories of 14 patients with definite PNS from the PNS Euronetwork database and from the authors' databases were reviewed. A PubMed literature search identified 23 patients with prostate cancer and PNS. Thus, a total of 37 case histories were reviewed with respect to syndrome type, cancer evolution, paraclinical investigations, antibody status, treatment and outcome. The three most frequent isolated PNS were paraneoplastic cerebellar degeneration, paraneoplastic encephalomyelitis (PEM)/limbic encephalitis and subacute sensory neuronopathy (SSN). Onconeural antibodies were detected in 23 patients, in most cases the Hu antibody (17 patients, 74 % of all antibody-positive cases). Other well-characterized onconeural antibodies (Yo, CV2/CRMP5, amphiphysin, VGCC antibodies) were found in a minority. PNS was diagnosed prior to prostate cancer diagnosis in 50 % of the cases. The association of PNS with prostate cancer is quite infrequent, but clinically important. PNS often heralds prostate cancer diagnosis. Syndromes associated with Hu antibodies predominate. Another tumor more prone to associate with PNS should always be excluded.

Subacute-onset paraneoplastic autonomic neuropathy associated with prostate cancer

“…Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide [5]. It has been rarely reported in association with paraneoplastic neurological syndromes (PNS): in the most recent review on this topic, among 37 reported cases with PNS and prostate cancer, only one patient presented with anti-Hu-associated limited gastrointestinal neuropathy, and no one with pandysautonomia [6].…”

Paraneoplastic Neuropathies: What's New Since the 2004 Recommended Diagnostic Criteria

“…Other associated malignancies are breast and ovarian cancer, and thymoma. Prostate cancer is an infrequent finding in the neurological paraneoplastic context, considering the frequency of the neoplasm, although cases of SSN have been reported with Hu antibodies (50). When the diagnosis of PNS is performed in a patient with an unknown or occult malignancy, oncological screening must be performed as recommended (51).…”

Paraneoplastic sensorimotor polyneuropathy in prostatic adenocarcinoma

“…Therefore, to properly diagnose PNS, additional examinations designed to detect specific antineuronal antibodies in serum or cerebrospinal fluid are required. [ 1 , 3 , 4 ]…”

“…[ 5 ] Antibody-positive paraneoplastic syndrome in prostate cancer occurs at a higher frequency if the pathologic finding is small-cell prostatic cancer than adenocarcinoma of prostate. [ 3 , 7 , 8 ] In general, PNS tends to stabilize or improve following cancer treatment. [ 2 , 4 ] This case report describes for the first time a case of anti-Hu antibody-positive paraneoplastic sensory-motor neuropathy that did not respond well to treatment in a 75-year-old male adenocarcinoma prostate cancer patient.…”