Guillain-Barré Syndrome after PCa Diagnosis... Anyone?

[pjoshea13]

A Danish study [1] has identified an increased risk of Guillain-Barré Syndrome [GBS] with certain cancers, including PCa.

"Cancer may increase the risk of developing Guillain-Barré syndrome (GBS) due to molecular mimicry or immunosuppression, but the exact relationship is unclear. We aimed to determine the association between incident cancer and the following risk of GBS development."

"Of the 2,414 patients with GBS and 23,909 controls included, 49 cases (2.0%) and 138 controls (0.6%) had a recent cancer diagnosis, respectively, yielding a matched odds ratio (OR) of 3.6 ... for GBS associated with cancer."

"The GBS ORs were highest for cancers of the lymphatic and hematopoietic tissue (OR, 7.2 ..., respiratory tract (OR, 5.6 ...), prostate and other male genital organ (OR, 5.0 ...) and breast cancer (OR, 5.0 ...)."

***

However, in a 2019 paper [2] from Taiwan:

"Androgen deprivation therapy for prostate cancer and the risk of autoimmune diseases"

"The autoimmune diseases included Graves' disease, Crohn's disease, psoriasis, systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, Guillain-Barre syndrome, Sjogren's syndrome, myasthenia gravis, pernicious anemia, hereditary hemolytic anemia, polyarteritis nodosa, Celiac disease, uveitis, polymyalgia rheumatica, dermatomyositis, Hashimoto's thyroiditis, hypersensitivity vasculitis, Behcet's disease, polymyositis, alopecia areata, Wegener's granulomatosis, ulcerative colitis, autoimmune hemolytic anemia, pemphigus, multiple sclerosis, systemic sclerosis, Goodpasture syndrome, giant cell arteritis, thromboangitis obliterans, arteritis obliterans, and Kawasaki disease."

"A propensity score-matched analysis (adjusted hazard ratio (aHR), 0.619 ...) demonstrated a significantly decreased risk of autoimmune diseases in ADT users."

***

It was noted some time ago that young males do not adequately respond to the annual flu vaccine. Older males, with much lower testosterone, produce enough protective antibodies within two weeks.

Testosterone dampens the immune response. Women have a much stronger immune response than men. The downside is that they are more likely to develop an autoimmune disease.

ADT, of course, is a form of castration. Might that result in estrogen-dominance & increased autoimmune risk? No, because men make most of their estrogen from aromatization ot testosterone [T] to estradiol [E2] (and androstenedione to estrone).

Most men on ADT do not have enough estradiol for basic bone health (& should consider an add-back low-dose E2 patch.) Estrogen dominance is not an issue during ADT.

However, for the majority of PCa cases where ADT is not used, at least initially, estrogen-dominance is not at all unusual.

{That's quite a list (above) - so many things that could occur! A good reason to restore normal T levels in the aging male?}

{Also, while on an ADT "vacation", it might be a good idea to normalize the E2:T ratio, T takes many months to recover & estrogen-dominance may develop.}

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/352...

Neurology

. 2022 Mar 2;10.1212/WNL.0000000000200015. doi: 10.1212/WNL.0000000000200015. Online ahead of print.

Association Between Incident Cancer and Guillain-Barré Syndrome Development: A Nationwide Case-Control Study

Lotte Sahin Levison 1 , Reimar Wernich Thomsen 2 , Søren Hein Sindrup 3 , Henning Andersen 4

Affiliations collapse

Affiliations

1 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark [e-mail].

2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

3 Department of Neurology, Odense University Hospital, Odense, Denmark.

4 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.

PMID: 35236772 DOI: 10.1212/WNL.0000000000200015

Abstract

Background and objectives: Cancer may increase the risk of developing Guillain-Barré syndrome (GBS) due to molecular mimicry or immunosuppression, but the exact relationship is unclear. We aimed to determine the association between incident cancer and the following risk of GBS development.

Methods: We conducted a nationwide population-based case-control study of all patients with first-time hospital-diagnosed GBS in Denmark between 1987 and 2016 and 10 age, sex and index date-matched population controls per case. We identified incident cancer diagnoses between six months prior to and two months after the GBS index date. We used conditional logistic regression to compute ORs as a measure of relative risk and performed stratified analyses to assess the impact of cancer on GBS risk in strata of calendar-periods, sex and age. In sensitivity analyses, to assess any potential risk of survival bias induced by including cancer diagnoses potentially made after GBS diagnosis, we examined incident cancers in both a broader exposure window (one year before to three months after GBS index date) and a narrower window (six months to one month before the GBS index date).

Results: Of the 2,414 patients with GBS and 23,909 controls included, 49 cases (2.0%) and 138 controls (0.6%) had a recent cancer diagnosis, respectively, yielding a matched odds ratio (OR) of 3.6 (95% confidence interval (CI), 2.6- 5.1) for GBS associated with cancer. Stratification by calendar time, gender and age showed robust results for the association between cancer and GBS, with no major variations. Broadening and narrowing the exposure window produced slightly weakened associations of OR, 2.4 (95% CI, 1.8-3.3) and OR, 2.5 (95% CI, 1.5-4.1), respectively. The GBS ORs were highest for cancers of the lymphatic and hematopoietic tissue (OR, 7.2; 95% CI, 2.9-18.0), respiratory tract (OR, 5.6; 95% CI, 2.7-11.9), prostate and other male genital organ (OR, 5.0; 95% CI, 2.1-11.6) and breast cancer (OR, 5.0; 95% CI, 1.7-14.5).

Discussion: In this large nationwide epidemiologic study, incident cancer was associated with a markedly increased risk of subsequent GBS development. The results suggest that yet unidentified factors present in several types of cancer drive this association.

© 2022 American Academy of Neurology.

***

[2] pubmed.ncbi.nlm.nih.gov/306...

Prostate Cancer Prostatic Dis

. 2019 Sep;22(3):475-482. doi: 10.1038/s41391-019-0130-9. Epub 2019 Jan 28.

Androgen deprivation therapy for prostate cancer and the risk of autoimmune diseases

Jui-Ming Liu 1 2 3 , Cheng-Ping Yu 4 , Heng-Chang Chuang 1 , Chun-Te Wu 5 , Ren-Jun Hsu 6 7 8

Affiliations expand

PMID: 30692587 DOI: 10.1038/s41391-019-0130-9

Abstract

Background: Androgen deprivation therapy (ADT) has been a mainstay of treatment for advanced prostate cancer (PCa), but limited studies have been performed to investigate the association between ADT and autoimmune diseases.

Methods: We conducted a population-based nationwide cohort study of 17,168 patients newly diagnosed with PCa between 1996 and 2013 using the National Health Insurance Research Database (NHIRD) of Taiwan. Cox proportional hazards models with 1:1 propensity score-matched analysis were used to investigate the association between ADT use and the risk of autoimmune diseases. The autoimmune diseases included Graves' disease, Crohn's disease, psoriasis, systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, Guillain-Barre syndrome, Sjogren's syndrome, myasthenia gravis, pernicious anemia, hereditary hemolytic anemia, polyarteritis nodosa, Celiac disease, uveitis, polymyalgia rheumatica, dermatomyositis, Hashimoto's thyroiditis, hypersensitivity vasculitis, Behcet's disease, polymyositis, alopecia areata, Wegener's granulomatosis, ulcerative colitis, autoimmune hemolytic anemia, pemphigus, multiple sclerosis, systemic sclerosis, Goodpasture syndrome, giant cell arteritis, thromboangitis obliterans, arteritis obliterans, and Kawasaki disease. The duration of ADT use as a time-dependent variable was also examined for its association with autoimmune diseases. We also performed six secondary analyses.

Results: Of the 17,168 selected PCa patients, 14,444 patients met all the inclusion and exclusion criteria. After propensity score matching, 5590 ADT users and 5590 non-ADT users were included in the study cohort. A propensity score-matched analysis (adjusted hazard ratio (aHR), 0.619, 95% confidence interval (CI), 0.51-0.75, P < 0.001) demonstrated a significantly decreased risk of autoimmune diseases in ADT users. A significant decrease in the risk of autoimmune diseases with increasing ADT duration was also demonstrated (P < 0.001).

Conclusions: We observed that ADT use in patients with PCa was associated with a decreased risk of autoimmune diseases. These novel findings provide a potential role for androgen deprivation therapy in the modification of inflammation and autoimmunity in Asian patients with prostate cancer.

[Scout4answers]

Thanks PatrickSo much to think about and pay attention to

[treedown]

Seems like conflicting info for this group of I am reading it right.

[pjoshea13 in reply to treedown]

For those not on ADT, it is a warning that a high estradiol:testosterone ratio (estrogen-dominance) might increase the risk of Guillain-Barré Syndrome by a factor of 5 or more, IMO. The E2:T ratio is something that can be manipulated, i.e. corrected.

For those on ADT, one can perhaps take solace that the loss of T has an upside. Albeit one of the few.

-Patrick

[j-o-h-n]

Ho Hum (yawn yawn).... just another thing to worry about.....I'm still worrying about the Government's covid booster recommendation giving us the crabs...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/04/2022 6:39 PM EST