A Case of Localized Prostate Cancer Associated with Polymyalgia Rheumatica with Marked Symptomatic Improvement after...

Area of Science:

• Rheumatology
• Oncology
• Immunology

Background:

• Polymyalgia rheumatica (PMR) is an inflammatory condition often treated with corticosteroids.
• Paraneoplastic syndromes occur when cancer triggers an immune response causing symptoms distant from the tumor.
• This case explores the link between an undiagnosed malignancy and refractory PMR symptoms.

Observation:

• A 73-year-old male presented with fever and severe bilateral shoulder and hip pain, initially diagnosed as PMR.
• Standard corticosteroid treatment (prednisolone 15 mg/day) provided no relief for his symptoms.
• Further investigations revealed an underlying diagnosis of prostate cancer (PCa) without metastasis.

Findings:

• Robot-assisted radical prostatectomy was performed to treat the prostate cancer.
• Following surgery, the patient experienced a dramatic resolution of his PMR-related symptoms.
• The patient's prednisolone dosage was successfully reduced to 4 mg/day post-operatively.

Implications:

• Prostate cancer should be considered in the differential diagnosis of elderly patients with new-onset or refractory PMR.
• PCa may induce PMR through immune-mediated inflammatory pathways, highlighting a potential paraneoplastic etiology.
• This case underscores the importance of a thorough oncological workup for unexplained inflammatory conditions.