Fever as a first presentation of castration-resistant prostate cancer: A case report

RATIONALE: Cancer is a well-recognized cause of fever, which is related to cytokines produced by malignant cells. Prostate cancer presenting with fever and other inflammatory markers as a paraneoplastic syndrome rarely occurs. PATIENTS CONCERNS AND DIAGNOSES: We describe the case of high fever and lower-urinary tract symptoms that progressed 1 month prior to presentation. A 78-year-old man had been diagnosed with prostate cancer 8 months ago. He received androgen deprivation therapy with leuprolide acetate 22.5 mg for every 3 months. Castration-resistant prostate cancer was diagnosed due to elevated prostate specific antigen (1639 ng/mL) and cancer fever. INTERVENTION: The patient received docetaxel-based systemic chemotherapy 50 mg/mm(2) biweekly. Naproxen 500 mg was administered twice a day. OUTCOMES: After one cycle of systemic chemotherapy, the patient had no major side effects, no more fever was observed, and the systemic condition improved. CONCLUSION: Differentiating cancer-related fever from infection-related fever is important for appropriate patient management. In this case, fever appeared as the first symptom of castration-resistant prostate cancer and was managed by naproxen and resolved with systemic chemotherapy.