Inflammatory prostate cancer: An underestimated paraneoplastic clinical manifestation

Purpose: To identify the incidence of prostate cancer associated-systemic inflammatory syndrome (SIS), and to characterize further this entity, we searched our database as well as the medical literature. Methods: We retrospectively analyzed all patients with prostate cancer admitted to the Department of Medical Oncology of the Ioannina University Hospital during the last 3 years. Systematic review of peer-reviewed medical literature was further performed at 3 major libraries (i.e., MEDLINE, ISI Web of Science, and Cochrane Central Register of Controlled Trials). No publication year or language restriction was set in the literature search. Results: Retrospective analysis of our patient population identified 4 patients with a SIS (of 63 patients who were metastatic hormone resistant), in whom fever was a sign of disease progression. Inversely, only 4 cases of prostate cancer-related fever were found in the literature, in all of them at disease presentation. Consequently, the incidence of inflammatory syndrome in metastatic prostate cancer seems to be strongly underestimated. A SIS can be an early or late event during the course of the disease, and is generally associated with rapid progression and bad prognosis. Back pain, fatigue, night sweats, anemia, bone metastases, and bone marrow infiltration are the most commonly associated signs and symptoms. Because of occasional responses to hormonal or chemotherapeutic treatment, prompt differential diagnosis and therapy are required. Conclusions: The role of proinflammatory cytokines in biochemical pathways of neoplastic growth has been established in prostate cancer, along with evidence for high levels of interleukin (IL)-6 among patients with hormone refractory disease. However, little is known about the frequency of a SIS in patients with prostatic carcinoma. (c) 2005 Elsevier Inc. All rights reserved.