攝護腺癌相關之附腫瘤神經症候群: 病歷報告及文獻回顧
陳鴻毅、林承家、黃賢祥、林政鋒、陳文祥、吳俊德
基隆長庚醫院 外科部 泌尿科
Paraneoplastic neurological syndrome in prostate cancer: A case report and review of literature
Hung-Yi Chen, Cheng-chia Lin, Shian-Shiang Huang, Cheng-Feng Lin, Wen-Hsiang Chen, Chun-Te Wu
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung
Case report:
Paraneoplastic neurological syndromes (PNS) are defined as the remote effects of cancer on the nervous system, which are relative rare in prostate cancer.. Here we reported a 65-year-old man who initially presented with insidious onset unsteady gait and foot numbness. The numbness was exacerbating, ascending from toes to ankles with symmetric distribution. The muscle power, pin-prick and vibration sensation were also diminished distally. During neurology hospitalization, nerve conductions and electromyographic study indicated a generalized sensorimotor peripheral neuropathy and a detail neuropathic risk factors survey showed elevated prostate specific antigen level (9.99ng/ml), prostate adenocarcinoma was proved at further biopsy. The neuropathic sign/symptoms, including distal weakness and numbness, all showed dramatically improvement after radical prostatectomy. We reviewed the literature on prostate cancer – related PNS. High-risk prostate cancer can trigger PNS and a rapidly progressive neurological syndrome with a bad prognosis.
Conclusion:
The causes of paraneoplastic syndromes in prostate cancer are incompletely understood. Even the pathogenesis of paraneoplastic neuropathies are immune mediated, results of conventional immunotherapy are always disappointed. The most effective treatment of is removal of the underlying malignancy.