TY - JOUR T1 - Foreign accent syndrome as a heralding manifestation of transformation to small cell neuroendocrine prostate cancer JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2022-251655 VL - 16 IS - 1 SP - e251655 AU - Amanda Broderick AU - Matthew K Labriola AU - Neal Shore AU - Andrew J Armstrong Y1 - 2023/01/01 UR - http://casereports.bmj.com/content/16/1/e251655.abstract N2 - 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. ER -