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Foreign accent syndrome as a heralding manifestation of transformation to small cell neuroendocrine prostate cancer
  1. Amanda Broderick1,
  2. Matthew K Labriola2,
  3. Neal Shore3 and
  4. Andrew J Armstrong4
  1. 1Department of Internal Medicine, Duke University Health System, Durham, North Carolina, USA
  2. 2Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina, USA
  3. 3Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA
  4. 4Divisions of Medical Oncology and Urology, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Amanda Broderick; amanda.broderick{at}; Dr Andrew J Armstrong; andrew.armstrong{at}


A man in his 50s with metastatic hormone-sensitive prostate cancer, receiving androgen deprivation therapy and abiraterone acetate/prednisone, presented with an uncontrollable ‘Irish brogue’ accent despite no Irish background, consistent with foreign accent syndrome (FAS). He had no neurological examination abnormalities, psychiatric history or MRI of the brain abnormalities at symptom onset. Imaging revealed progression of his prostate cancer, despite undetectable prostate-specific antigen levels. Biopsy confirmed transformation to small cell neuroendocrine prostate cancer (NEPC). Despite chemotherapy, his NEPC progressed resulting in multifocal brain metastases and a likely paraneoplastic ascending paralysis leading to his death. We report FAS as the presenting manifestation of transformation to small cell NEPC, a previously undescribed phenomenon. His presentation was most consistent with an underlying paraneoplastic neurological disorder (PND), despite a negative serum paraneoplastic panel. This report enhances the minimal existing literature on FAS and PNDs associated with transformed NEPC.

  • Prostate Cancer
  • Neurology
  • Immunology

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  • Twitter @ABroderickMD, @AarmstrongDuke

  • Contributors AB drafted and revised the case report and gathered/analysed all of the patient information together. MKL gathered data about the patient, helped with the overall conception of the report and critically revised the report. NS cared for the patient, acquired additional data and information about the patient, and critically revised the report. AA cared for the patient, contributed to the conception/design of the report, and drafted and critically revised the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests In the last 36 months, AA is disclosing institutional grant funding (to Duke University) from Pfizer, Astellas, Bayer, Dendreon, Genentech/Roche, Merck, BMS, Amgen, AstraZeneca, Celgene, Forma, Janssen, NIH, DOD, and PCF/Movember; and consulting/advisor relationships with Pfizer, Astellas, Bayer, Dendreon, Genentech/Roche, Merck, BMS, AstraZeneca, Forma, Janssen, Myovant, Exelixis and Exact sciences. There are no other competing interests to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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