Paraneoplastic jaundice and prostate cancer

[Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases]

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment.

Endocrine and paracrine characteristics of neuroendocrine prostate cancer

Prostate cancer is a common malignancy affecting men worldwide. While the vast majority of newly diagnosed prostate cancers are categorized as adenocarcinomas, a spectrum of uncommon tumor types occur including those with small cell and neuroendocrine cell features. Benign neuroendocrine cells exist in the normal prostate microenvironment, and these cells may give rise to primary neuroendocrine carcinomas. However, the more common development of neuroendocrine prostate cancer is observed after therapeutics designed to repress the signaling program regulated by the androgen receptor which is active in the majority of localized and metastatic adenocarcinomas. Neuroendocrine tumors are identified through immunohistochemical staining for common markers including chromogranin A/B, synaptophysin and neuron specific enolase (NSE). These markers are also common to neuroendocrine tumors that arise in other tissues and organs such as the gastrointestinal tract, pancreas, lung and skin. Notably, neuroendocrine prostate cancer shares biochemical features with nerve cells, particularly functions involving the secretion of a variety of peptides and proteins. These secreted factors have the potential to exert local paracrine effects, and distant endocrine effects that may modulate tumor progression, invasion, and resistance to therapy. This review discusses the spectrum of factors derived from neuroendocrine prostate cancers and their potential to influence the pathophysiology of localized and metastatic prostate cancer.

Prostate Cancer Presenting with Pruritus and Cholestasis

Jaundice is a rare symptom of the paraneoplastic syndrome associated with prostate cancer. We report a case of metastatic prostate cancer that presented as jaundice. There was an absence of biliary obstruction and hepatic metastasis; therefore, the paraneoplastic syndrome was suggested as the etiology of cholestasis. Jaundice improved with the treatment of prostate cancer. In the literature, interleukin-6 has been suggested to be associated with paraneoplastic syndrome.

Metastatic Prostate Cancer Manifesting as Cholestatic Jaundice: A Case Report and Review of the Literature

A paraneoplastic syndrome can often present as the first manifestation of an underlying malignancy. We report a patient who presented with cholestatic jaundice as a paraneoplastic syndrome from his newly diagnosed metastatic prostate cancer. He received initial treatment with androgen deprivation therapy followed by six cycles of docetaxel resulting in resolution of his cholestatic process, normalization of liver enzyme levels, and excellent biochemical and radiographic response. To the best of our knowledge, this is the first reported case of metastatic prostate cancer with cholestatic jaundice as a paraneoplastic phenomenon to be safely treated with androgen deprivation therapy and upfront docetaxel, reflecting the latest shift in the treatment of metastatic prostate cancer.

Cholestatic Jaundice as a Paraneoplastic Manifestation of Prostate Cancer Aggravated by Steroid Therapy

OBJECTIVE

To report a rare case of paraneoplastic jaundice as a manifestation of prostate cancer.

CLINICAL PRESENTATION AND INTERVENTION

We report on a case of paraneoplastic syndrome in a 72-year-old man with prostate cancer that manifested with idiopathic jaundice. Although steroids can be used as treatment in patients with prostate cancer, they could exacerbate paraneoplastic jaundice. The jaundice that flared up after treatment with 40 mg prednisone was improved with antiandrogen treatment.

CONCLUSION

Physicians should be aware of the possibility of paraneoplastic jaundice in patients with prostate cancer. Appropriate antiandrogen therapy should be considered for paraneoplastic jaundice in these patients.