Unilateral nerve-sparing radical prostatectomy and hemicystectomy in management of prostate sarcoma

Prostatic stromal sarcoma in a young adult: a case report

Prostate stromal sarcoma is quite rare, comprising only 0.1-0.2% of all prostate cancers. Here, we report one case of prostate stromal sarcoma in a 38-year-old man. Initially, the patient suffered from lower urinary tract symptoms, and intravenous pyelography showed a larger filling defect in the bladder. Transrectal ultrasound showed a huge heterogenous mass between the bladder and rectum. Abdominal computed tomography revealed prostate tumor with local invasion. Radical cystoprostatectomy with ileal conduit was performed; pathology revealed high-grade prostate stromal sarcoma with invasion to the right seminal vesicle and urethra. This article describes the pathology and immunohistrochemical features of this case and briefly reviews the literature.

Adult prostate sarcoma: the M. D. Anderson Cancer Center Experience

PURPOSE

Sarcoma of prostate origin is rare. Historically, long-term survival rates for adult patients with prostate sarcoma are poor. We analyzed the experience of 1 institution with prostate sarcoma during the last 3 decades.

MATERIALS AND METHODS

The records of 21 patients with prostate sarcoma were reviewed to identify symptoms at presentation, diagnostic procedures, presence and development of metastases, staging evaluation, histological subtype, grade and size of the primary tumor, and treatment sequence, including surgery, and preoperative and postoperative therapies. Several clinicopathological variables were assessed for prognostic importance.

RESULTS

Most patients presented with urinary obstruction. The diagnosis of prostate sarcoma was usually established with ultrasound guided biopsy or transurethral resection. Histological subtypes were leiomyosarcoma in 12, rhabdomyosarcoma in 4, malignant fibrous histiocytoma in 1 and unclassified sarcoma in 4 patients. At last followup, 8 patients had no evidence of disease after a median of 81.5 months (range 10 to 197). The remaining 13 patients died of sarcoma (median survival 18 months, range 3 to 94). The 1, 3 and 5-year actuarial survival rates for all 21 patients were 81%, 43% and 38%, respectively. Factors predictive of long-term survival were negative surgical margins (p = 0.0005) and absence of metastatic disease at presentation (p = 0.0004). Tumor size and grade, and the histological subtype of prostate sarcoma had no significant influence on actuarial survival.

CONCLUSIONS

The long-term disease specific survival rate for adults with prostate sarcoma is poor. Early diagnosis and complete surgical resection offer patients the best chance for cure.