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Introduction Prostate sarcoma is an extremely rare disease with a poor prognosis. Undifferentiated pleomorphic sarcoma has never been described in the prostate.Case presentation: A 27-year-old man complained of frequent urination and dysuria for several years. Various examinations were suggestive of prostate sarcoma. The pathological diagnosis was confirmed as prostate sarcoma via ultrasound-guided transrectal needle biopsy. Because the location of the tumor in the prostate was confirmed by magnetic resonance imaging, we performed robot-assisted radical prostatectomy. The final pathological diagnosis was undifferentiated pleomorphic sarcoma. Local recurrence occurred at the front of the rectum 2 months after surgery. Although chemotherapy and radiotherapy were initially effective, he died 18 months after surgery. Conclusion Undifferentiated pleomorphic sarcoma of the prostate is believed to have a poor prognosis. When selecting the surgical procedure, functionality should be considered for individual cases with complete resection.

Urinary retention and hematuria owing to radiation-induced mucositis are occasional late adverse events in patients with prostate cancer. Moreover, radiation-induced secondary malignancies are late adverse events, although they are extremely rare. Herein, we describe a case of radiation-induced secondary malignancy of the prostate that was initially difficult to distinguish from radiation mucositis. A 74-year-old man with prostate cancer underwent brachytherapy and external beam radiotherapy 9 years ago. Twenty-eight months after irradiation, he presented with urinary retention and hematuria owing to radiation mucositis and underwent transurethral resection of the prostate. At 89 months after irradiation, the patient again showed urinary retention and hematuria. The cause of urinary retention and hematuria could not be identified on cystoscopy. Despite receiving medications, the patient’s symptoms did not improve. Therefore, transurethral fulguration was performed, and prostate biopsy revealed spindle cell sarcoma. A diagnosis of radiation-induced undifferentiated pleomorphic/spindle cell sarcoma was made, and the patient underwent total cystectomy and construction of the ileal conduit. Two weeks after the surgery, computed tomography revealed peritoneal dissemination. The patient died 5 weeks after the surgery. The case findings indicate that clinicians should consider the possibility of radiation-induced secondary malignancy; moreover, thorough pathological examination of the prostate with CT and MRI is important to distinguish RISM from radiation mucositis even if no tumors are found on cystoscopy.

Background: Prostate sarcoma is a rare group of prostate primary malignant tumors with a poor prognosis, and its early diagnosis is challenging. Here we report a case of early diagnosis of prostate sarcoma and summarize the clinical characteristics of this group of patients. Case presentation: We present a case of a 40-year-old male patient with prostate leiomyosarcoma having hematospermia as the initial symptom. His prostate-specific antigen was 2.97 ng/ml, magnetic resonance imaging showed a prostate nodule with possible bleeding at the lesion margins with Prostate Imaging Reporting and Data System (PI-RADS) category 2. According to the guidelines, prostate biopsy was not recommended, but we learned from our previous experience and still recommended him for prostate biopsy. With his consent, a combined prostate biopsy was performed, and he received an early diagnosis of prostate leiomyosarcoma 19 days after the initial symptom of hematospermia. Reviewing previous cases of prostate sarcoma patients at our medical center, we found that the best time for diagnosis and treatment were generally missed. Conclusions: Combination with magnetic resonance imaging is contributive to the early diagnoses of prostate sarcoma. Therefore, when young patients present with repeated hematospermia, even if they have normal prostate-specific antigen, it is important to be alert to the possibility of prostate sarcoma, and multiparametric magnetic resonance imaging rather than ultrasound is recommended, and if MRI reveals prostate lesions, it is recommended to be biopsied regardless of PI-RADS categories, and a combined biopsy is recommended.

With the development of more sensitive screening tools, malignancies are being diagnosed at an earlier stage, resulting in earlier intervention and longer survival times. As a consequence, the long-term complications of cancer therapy are increasing in incidence, particularly second primary cancers from radiation therapy. Bladder and colorectal cancers are the most commonly reported malignancies secondary to radiation therapy for prostate cancer. We present the case of a 78-year-old patient with a remote history of prostate adenocarcinoma, status post brachytherapy, who subsequently developed both prostate sarcoma and prostate squamous cell carcinoma secondary to the prior treatment. Because his cancer was metastatic, he was not a candidate for surgery and was treated with chemotherapy and palliative radiation.

Background: Prostate sarcoma is a malignant tumor from the prostate stroma. However, its pathogenesis is unknown. This is a rare type of prostate tumor. Case Presentation: A rare case of prostate leiomyosarcoma has been described. A 55-year-old prostate leiomyosarcoma patient who suffered from progressive dysuria and frequent urination for half a year was examined. Pathology, immunohistochemical staining, and laparoscopic radical prostatectomy were performed using three-dimensional (3D) reconstruction to diagnose prostate leiomyosarcoma. The patient did not receive adjuvant therapy after the operation. Final pathology was used to confirm prostate leiomyosarcoma. After one year of follow-up, the patient regularly underwent a digital rectal examination and abdominal MRI. However, no tumor recurrence or metastasis was found. Discussion: We discussed diagnosis and treatment of prostate leiomyosarcoma and reviewd literatures. Conclusion: Prostate leiomyosarcoma is a rare special type of prostate tumor, and its diagnosis is mainly based on pathological features. Radical excision is the primary treatment for prostate leiomyosarcoma. The 3D reconstruction is essential in the surgery because it can determine the size of the tumor and its relationship to the surrounding tissue. A postoperative adjuvant therapy can also be performed.

Sarcomas and related proliferative lesions of the specialized stroma of the prostate are very rare and have been classified into prostate stromal sarcoma (PSS) and prostatic stromal tumor of uncertain malignant potential based on histology. We herein describe a case of PSS. A 40-year-old male presented at a hospital with urinary distention. Magnetic resonance imaging revealed a large prostate mass, and the diagnosis was prostate sarcoma of uncertain differentiation by ultrasound-guided needle biopsy. Total pelvic exenteration was performed and a pathological diagnosis of PSS was ultimately reached. Ten months later, there have been no signs of metastasis or recurrence.

Background Primary prostate sarcomas (PPS) are rare. Outcomes for this cancer have not been well characterized. Materials and methods Subjects with a PPS diagnosed between 1973 and 2014 were identified in the SEER database. Subjects were stratified by disease stage and types of therapies received. Disease-specific survival (DSS) and Overall survival (OS) was estimated by Kaplan-Meier analysis and cohorts were compared with a univariate and multivariable Cox regression. Results The incidence of PPS among all prostate cancer diagnoses was 0.02%. Subjects younger than age 26 years at diagnosis represented 29% of cases, and 32% of primary prostate sarcomas were rhabdomyosarcoma histology. Rhabdomyosarcoma histologies The median age at diagnosis was 9 years. Between age 0-25 years rhabdomyosarcoma accounted for 96.4% of primary prostate sarcoma diagnoses, after age 25 rhabdomyosarcoma represented 15% of new diagnoses. The 10-year DSS and OS for rhabdomyosarcoma was 47% and 44%. Non-rhabdomyosarcoma histologies The median age at diagnosis was 71 years. The most common diagnoses were leiomyosarcoma (33%) and carcinosarcoma (28%). Localized, regional, or distant disease occurred in 40%, 34%, and 26% of cases. The 10-year DSS and OS were 26% and 14%. In locally advanced cases, RT added to surgery trended toward improved DSS (P = 0.10). Conclusions Disease-specific survival and OS for non-rhabdomyosarcoma histologies appear inferior to those of rhabdomyosarcoma. The addition of RT to surgical resection may improve DSS in locally advanced non-rhabdomyosarcoma. This is the largest report of the incidence, stage distribution, and survival for this extremely rare urologic malignancy providing valuable prognostic information.

Most previous studies on palliative rehabilitation highlight medical care, with occupational therapy (OT) primarily focused on normal and instrumental activities of daily living. This clinical report describes the case of a 35-year-old patient with prostate sarcoma with a poor prognosis who received OT to help him focus on participating in a meaningful occupation. Initially, the patient was depressed and withdrawn, but with OT, he was able to participate in an occupation, and his life became more active. Although the patient was at the end of his life, he was able to maintain a high quality of life during the limited time period.

Rationale: Prostatic sarcoma (PS) is a very rare malignant tumor that accounts for

Introduction: Primitive neuroectodermal tumor (PNET) is a very rare type of prostate sarcoma that mostly occurs in young adults, and it is associated with a poor prognosis. Case Presentation: A 37-year-old male was admitted with intermittent painless gross hematuria from 1 month prior to admission. Cystosocopy, abdominopelvic computed tomography scan (ACTS), and magnetic resonance imaging (MRI) revealed huge prostate. All tumor markers were negative and pathology findings of trans-rectal ultrasonographic biopsy (TRUS Bx) and trans-urethral resection of prostate (TURP) were consistent with severely inflamed prostatic urethra with no evidence of malignancy. The patient underwent radical prostatectomy. Histopathology of the specimens showed malignant neoplasm of small round and oval cells suggestive of PNET. Immunohistochemistry (IHC) study results on CD99 were positive. Conclusions: We report a rare uncommon case of prostate PNET presented by intermittent painless gross hematuria. As the prognosis is very poor, medical staff should pay enough attention to the differential diagnosis, choosing the best treatment and subjects close follow-up.

Prostatic rhabdomyosarcoma (RMS) is a subtype of prostate sarcoma which is rarely reported in adults and usually huge in size. Although there is no consensus on the standard therapy to prostatic RMS, complete resection with negative margin is identified as the best way for maximum survival time. However, to remove a much enlarged prostate completely from a RMS patient is still a very difficult task for a skilled urologist so far. As three-dimension (3D) technology becomes more widely used in medicine, surgeons have the opportunity to challenge previously impossible surgery. In this paper, we reported a 36-year-old male patient with a 9.6*5.3*7.6 cm prostatic RMS. With the aid of 3D reconstructed video and printing model, the giant tumor was entirely removed without surgery complications and adjacent organs injury. The patient was alive and had no recurrence after 18 months from surgery. This case revealed that 3D reconstruction technology could help in the preoperative assessment and gave benefits to both patients and surgeons.

Prostate sarcoma is a rare malignancy with an extremely poor prognosis. The extremely low morbidity and atypical clinical symptoms contribute to a missed diagnosis. The typical features of prostate sarcoma in transrectal ultrasound (US) and magnetic resonance imaging, such as a markedly enlarged volume and irregular prostatic contours, cannot usually be found until dysuria or even uroschesis occurs, and may then be too late to treat. However, there appears to no specific tumor marker for the disease in the serum. The present study reports a case of a young male patient who was diagnosed with prostate rhabdomyosarcoma. This was, to the best of our knowledge, the first case of this diagnosis using contrast-enhanced US (CEUS) when the symptoms were not severe. In this case, the intralesional non-enhancement areas and rim-like hyper-enhancement around the lesion were considered to be the main CEUS features of prostate rhabdomyosarcoma. The present study also reviews the associated literature.

Prostate sarcoma, particularly the pathological type of leiomyosarcoma, is a rare carcinoma, which originated from the interstitial tissue of the prostate. This sarcoma type has a poor prognosis. This disease accounts for ~0.1% of all prostate cancer and it usually occurrs in patients aged between 40 and 78-years-old. Although prostate leiomyosarcoma has a poor prognosis, early treatment of post-operative recurrence and metastases via a whole-body examination and closer follow-up was possible. These measurements may significantly prolong the survival time and improve the quality of life. The present study reported a successful case of surgical management for prostate leiomyosarcoma in the Zigong No. 4 People's Hospital (Sichuan, China) during 1995 until 2015, with post-operative follow-up for 20 years.

Evaluation of the primary spindle cell sarcoma prostate, which is seen extremely rare, is aimed. Literature search was made through a search in the MedLine database using PubMed and Scopus for the articles published between January 1988 and September 2013. Electronic search was limited to the following keywords: “ spindle cell sarcoma”, “primary prostate sarcoma”. Primary prosatate sarcoma was reported as 100 patients in literature. High-grade primary spindle cell sarcoma of the prostate was encountered as 16 patients in literature. This patients was reported as the 17th case. It is a difficult cancer due to diagnosis and treatment b ecause of the short average life expectancy , high potential of asymptomatic aggressive and metastatic . Histopatogenesis is not exactly known . In 50 % of composed of patients who are previously diagnosed with prostate adeno carcinom. The case was reported as high-grade primary prosatate sarcoma at an early age. The case is different from other cases because of not being adenocarcinom component. World J Oncol. 2013;4(6):258-261 doi: http://dx.doi.org/10.4021/wjon757w

Objective To analyze the clinical characteristics, treatment modalities, and outcomes of adult prostate sarcoma treated at our institution. Materials and Methods The medical records of 25 adult patients with prostate sarcoma were obtained from January 1989 to December 2009. The clinicopathologic parameters were evaluated to determine their effect on survival. Results The median age was 37 years (range 18-81). The median tumor size was 9.5 cm (range 4-25). The median serum prostate-specific antigen level was 1.39 ng/mL (range 0.39-33.20). The most common symptom was dysuria (72%). Transrectal ultrasound-guided needle biopsy was used to diagnose 22 sarcomas, transurethral resection of the prostate to diagnose 2, and open surgery to diagnose 1. The predominant histologic subtype was leiomyosarcoma (40%); 21 (88%) were high grade and 6 patients had metastatic disease. Surgical resection of curative intent was performed in 14 patients, with negative margins in 10. After a median follow-up of 21 months (range 5-63), 2 patients were disease free, 4 were alive with disease, and 19 had died of their disease. Overall, the 1-, 2-, 3-, and 5-year survival rate was 80.0%, 47.4%, 22.6%, and 11.3%, respectively, and the median survival time was 23 months. The median survival time after recurrence was 20 months (range 9-39) and that after metastasis was 10 months (range 3-23). Age >50 years, metastasis at presentation, and a lack of surgery with curative intent were independently predictive of an unfavorable outcome. Conclusion Adult prostate sarcoma accounted for 0.7% of primary prostate malignancies and carried a poor prognosis. Early diagnosis and surgical resection with curative intent offer patients the best chance of survival.

This report describes a spontaneous prostate fibromyxoid sarcoma with smooth muscle differentiation in an approximately 136-week-old intact male F344xBNF1 rat on a diet study for 2 weeks. At necropsy, the prostate was markedly distorted and enlarged by a firm white multinodular mass (6.0 × 4.5 × 3.5 cm). Histopathologically, the mass consisted of solid sheets of interlacing mesenchymal spindle cells with indistinct cell borders. Nuclei were separated by variable amounts of hyaline to fibrillar eosinophilic and/or myxomatous material. The extracellular myxomatous material tended to form whorls and stained positively with alcian blue. The mass stained strongly with Masson trichrome and vimentin throughout. Approximately 5% of the neoplastic cells were positive for smooth muscle actin, and none stained for desmin and pancytokeratin. To the authors’ knowledge, this fibromyxoid sarcoma with smooth muscle differentiation is the first such described prostatic sarcoma in a rat.

Rationale: Prostate sarcoma has been reported to represent 0.7% of primary prostate malignancies. Leiomyosarcoma and rhabdomyosarcoma are the most common sarcomas of the prostate. Malignant peripheral nerve sheath tumor (MPNST) of the prostate is very rare. Patient concerns: A 22-year-old man presented with gross hematuria and voiding difficulty for 2 weeks. Magnetic resonance imaging showed a 6-cm mass in the left lobe of the prostate. Diagnoses: Core needle biopsy results revealed high-grade sarcoma, suggestive of poorly differentiated synovial sarcoma. The final diagnosis of laparoscopic prostatectomy was MPNST, because it did not show the presence of SYT-SSX fusion transcripts on reverse transcription polymerase chain reaction analysis. Interventions: Adjuvant radiotherapy was planned because preoperative positron emission tomography-computed tomography (CT) did not show any metastatic lesion and the resection margin was microscopically involved. However, chest CT showed multiple lung metastases a month after prostatectomy. A chemotherapeutic regimen of doxorubicin and ifosfamide was administered. Outcomes: The best response to chemotherapy was partial response. After several courses of chemotherapy, he died 9 months after the surgery. Lessons: Primary prostate sarcoma and even MPNST are extremely rare. MPNST of the prostate has seldom been reported. This report may help diagnose and manage the disease.

Sarcoma is an unusual type of prostate cancer in adult. Prostate sarcoma (PS) is rare with only 183 cases reported in the English language medical literature from 1938-1998. Here we present a case of african.national who presented with locally advanced prostate sarcoma with thrombocythemia. However responded favourably to his initial trearment. He was treated with anthracycline based systemic chemotherapy; monoclonal antibody/large molecular target therapy (cyclophosphamide, liposomal adriamycin, vincristine, Cetuximab) for first three months without grade 3 or 4 toxicity. Then given synchronous chemo-target-radiation therapy in view of favourable initial radiological response and clinical benefit (effective palliation in terms of pain control and bleeding control).

Background The objective of this study was to evaluate the use of neoadjuvant chemoradiation in patients with prostate sarcoma treated at our institution and report oncological outcomes. Materials and methods The records of patients with intermediate- or high-grade prostate sarcoma treated with curative intent at our institution from 1993 to 2013 were reviewed. Patient demographic information, tumor characteristics, and treatment modalities used were assessed. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were calculated. Results Eight patients met inclusion criteria. The mean age at presentation was 64 years, and urinary obstruction was the most common presenting symptom. All patients underwent surgical resection and neoadjuvant radiation and 6 had concurrent chemotherapy. Four patients received intraoperative radiation. With a median follow-up of 36 months, there were no local recurrences, 6 metastases, 4 deaths from disease, and no deaths from other causes. The median OS and CSS was 67.8 months, with actuarial OS and CSS rates of 100% at 1 year, 75% at 2 years, 62.5% at 3 years, and 62.5% at 5 years. Median RFS was 14.2 months, with actuarial RFS rate of 75% at 1 year, 37.5% at 2 years, and 25% at 3 years. Conclusion Prostate sarcomas are rarely cured using surgical resection alone. Our cohort treated with a multimodality approach had favorable CSS and RFS compared with historic and contemporary series of surgery alone and no local recurrences. Most patients developed metastatic recurrence, highlighting the aggressive nature of this disease.

Introduction: The importance of implementation: Prostate cancer is the most common malignancy in men and the second leading cause of cancer death in developed countries. Therefore, further studies about the protests of disease, diagnosis and timely treatment are essential. Study Method: In this study, 80 prostate cancer patients admitted to Imam Khomeini Hospital, Urmia in Iran from 2000 to 2008 were reviewed. Patients were studied according to their age, clinical protests, Gleason scoring, positive family history, smoking, type of treatment and post-treatment conditions. Questionnaires were adjusted based on the objectives and the data were extracted from the medical records of patients and the desired results were achieved. Results: In this study, the most common age group for prostate cancer is older than 60 years (92/5%). The most common type of pathology for prostate cancer is adenocarcinoma that 93.75% of cases are included. Secondary TCC with secondary source is present in 5% and sarcoma in 1.25% of cases. 46.25% of patients with prostate cancer are smokers. The most common clinical symptoms among patients are obstructive symptoms (56.25%), and irritation of the urinary tract (52.81%). Hematuria in 26.25% and urinary incontinence in 5% of cases have been recorded. 16.3% of patients referred with metastatic symptoms. Most patients with prostate cancer have Gleason score 5-7 (40%). All patients were undergoing prostatectomy (82.5% TURP and 17.5% SPP) and 47.5% of cases were bilateral orchiectomy. The cases reviewed, 22 were followed that included 27.5% of cases. Among them, 6 people have died due prostate cancer (27.27%) that the mean age of the patients after diagnosis until death was 34.4 months. 2 others died from other causes (9.09%). The remaining 14 cases were elder patients with a mean follow-up duration of 44 months. Conclusion: According to the results obtained in the present study, the most common type of prostate cancer pathology is adenocarcinoma that is included 93.75% of cases. Prostate sarcoma is present at 1.25% and secondary bladder TCC at 5% of cases more over the incidence of prostate sarcoma is reported in a lower age group than adenocarcinoma, which the results obtained in a similar study in Iran in other centers. Regarding the relationship between smoking and prostate cancer it can be considered one of the important factors in this regard.

Sarcomas of the prostate are rare tumors. Imaging plays an important role in the management and diagnosis of patients with prostate sarcomas. Their clinic-pathologic features are well described, but the imaging features of these tumors have rarely been documented in the literature and have appeared mainly as case reports. Herein, we present a rare case of metastatic spindle cell sarcoma of prostate with computed tomography imaging findings.

Purpose: Primary prostate sarcomas are a rare type of prostate cancer that account for less than 0.1% of primary prostate malignancies. We analyzed the experience of a single institution with prostate sarcoma over 20 years. Materials and Methods: In this case series, the medical records of 20 patients with prostate sarcoma were reviewed from June 1990 to December 2013 to identify symptoms at presentation, diagnostic procedures, metastasis presence and development, histologic subtype, French Federation Nationale des Centres de Lutte Contre le Cancer grade, primary tumor grade and size, and treatment sequence, including surgery and preoperative and postoperative therapies. The average follow-up period was 23.6 months (range, 1.4–83.3 months). Results: The average patient age was 46.3±16.7 years. Most patients presented with lower urinary tract symptoms (55%). The histologic subtype was spindle cell sarcoma in five patients (25%), rhabdomyosarcoma in three patients (15%), synovial sarcoma in three patients (15%), liposarcoma in three patients (15%), stromal sarcoma in three patients (15%), and Ewing sarcoma, nerve sheath tumor, and adenocarcinoma with sarcomatoid component (5% each). For liposarcoma, two patients were alive after complete surgical resection and had a good prognosis. At last follow-up, 15 patients had died of sarcoma. The 2- and 5-year actuarial survival rates for all 20 patients were 53% and 12%, respectively (medial survival, 20 months). Conclusions: The disease-specific survival rate of prostate sarcoma is poor. However, sarcoma that is detected early shows a better result with proper management including surgical intervention with radio-chemotherapy than with no treatment. Early diagnosis and complete surgical resection offer patients the best curative chance.

Objective To present our institutional experience with adult prostate sarcoma over 30 years. Materials and Methods We reviewed 38 cases of adult prostate sarcoma diagnosed and treated at our institution between 1982 and 2012. Univariate Cox proportional hazards regression was used to determine if there was an association between specific disease characteristics (tumor size, histology, American Joint Committee on Cancer stage, and metastasis at diagnosis) and cancer-specific survival (CSS). Results A total of 38 patients were included, with a median age of 50 years (range, 17-73 years). Most men presented with lower urinary tract symptoms (45%), hematuria (24%), or acute urinary retention (21%). Diagnosis was established with prostate needle biopsy (68%) or transurethral resection of the prostate (18%). The predominant histologic subtypes were leiomyosarcoma (13 cases, 34%) and rhabdomyosarcoma (12 cases, 32%). Rhabdomyosarcoma was associated with poorer CSS (hazard ratio, 3.00; 95% confidence interval [CI], 1.13-7.92; P = .027) compared with leiomyosarcoma. We did not observe a significant relationship between tumor size and CSS. Overall, median CSS was 2.9 years (95% CI, 1.5-5.4), with 7.7 years for clinically localized disease (95% CI 2.5; upper bound not reached) and 1.5 years for metastatic disease (95% CI 1.1, 2.7). Conclusion Adult prostate sarcoma has a poor prognosis, especially in cases of metastatic disease at the time of diagnosis. Surgery remains the standard of care, but it provides limited benefit to those with metastatic disease or as a consolidation therapy after partial response to systemic therapy.

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.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.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.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.

We report the management and outcome of prostate sarcoma at 1 institution and analyze factors that may determine prognosis.The medical records of 10 patients with prostate sarcoma were reviewed to identify symptoms at presentation, diagnostic procedures, and staging methods. Histology, grade, tumor size, stage, and treatment modality were analyzed. Overall survival was assessed.Five patients had rhabdomyosarcoma (RMS) and five had other subtypes, including two with carcinosarcoma, two with high-grade sarcoma not-otherwise-specified, and one with leiyomyosarcoma. Eight patients presented with locally advanced disease and two with metastatic disease.The two metastatic patients received chemotherapy, and one also had hormonal ablation therapy. Of the eight with local disease, two had neoadjuvant chemotherapy and surgery, one had surgery alone, one had surgery and postoperative radiation, one had radiation alone, and three had chemoradiation.Chemotherapy consisted of vincristine, adriamycin, and cyclophosphomide for rhabdomyosarcoma and of cisplatin, adriamycin, and ifosphamide for the other subtypes. Radiation dose ranged from 40 Gy to 55.8 Gy.The median survival follow-up of the study is 46.5 months. The median survival for the rhabdomyosarcoma subgroup and nonrhabdomyosarcoma subroup is 142 months and 24 months, respectively. There were three deaths, of which two had metastatic disease at presentation and one later developed distant metastases after having surgery alone. One patient developed a local recurrence 47 months after chemoradiation and was successfully salvaged with surgery.In terms of tumor-related factors, the histologic subtype of prostate sarcoma appears to have prognostic significance. The overall survival for adults with non-RMS histologies is poor with a median survival of only 2 years. Pediatric patients with RMS faired much better with a median survival of over 10 years. We did not find any difference in outcome with regard to grade or tumor size. The presence of metastatic disease at diagnosis, however, is a poor predictor of outcome.In terms of treatment-related factors, surgery alone is inadequate treatment. One patient treated with surgery alone developed distant metastases 38 months later, then received chemotherapy and hormonal therapy, and died at 58 months. Patients who received combined modality treatment appear to fare better.Finally, these patients need long term follow-up. One patient developed a local recurrence 47 months after chemoradiation. This patient was successfully salvaged with surgery and is currently alive at 170 months.

Background. Leiomyosarcoma of the prostate is a rare neoplasm that accounts for less than 0.1% of prostate malignancies. Previous reports of this neoplasm consisted of single case studies or small series, often combined with cases of rhabdomyosarcoma. The relationship of prognosis with histologic and immunohistochemical findings has not, to the authors' knowledge, been described in a large series of cases, and the efficacy of various treatments is uncertain. Methods. The authors undertook a clinicopathologic study of all cases of prostate leiomyosarcoma observed at their institution from 1929 to 1994. Twenty-three cases were retrieved from the files of the Department of Pathology, Mayo Clinic (Rochester, MN), and clinical follow-up was available for 14. Immunohistochemical studies, including actin, desmin, S-100 protein, keratin, and vimentin were performed for 18 cases. Results. Patients ranged in age from 41 to 78 years, with a mean of 61 years. Presenting symptoms included urinary obstruction (100%), perineal pain (25%), burning on ejaculation (7%), and weight loss (7%). The neoplasms ranged from 3.3 to 21 cm (mean, 9 cm) in greatest dimension and were often associated with necrosis. Seven tumors were Grade 2, 10 Grade 3 and 6 Grade 4 (Broders' grading system; scale, 1–4). Mitotic figure counts varied from 2 to 24 per 10 high power fields. Fifteen of 15 (100%) cases were immunoreactive for vimentin, 10 of 16 (63%) were immunoreactive for actin, and 3 of 15 (20%) were weakly reactive for desmin. Keratin expression was observed in 4 of 15 cases (27%), and S-100 protein was negative in all cases. Treatment varied, and usually included a combination of radiation therapy, chemotherapy, and radical prostatectomy or cystoprostatecomy. Follow-up ranged from 2 to 72 months, with a mean of 19 months. Ten patients died from tumor 3 to 72 months (mean, 22 months) after diagnosis. Four patients were alive, including three with residual tumor and one without evidence of tumor at 2, 4, 30, and 4.5 months, respectively. Local recurrence occurred in 10 of 11 patients, including 5 who had gross residual tumor present after surgery. Metastases developed up to 40 months after surgery (mean, 10.3 months), and most frequently involved the lungs. Conclusions. These findings indicate that prostate leiomyosarcoma has a varied histologic appearance ranging from spindled cell neoplasm reminiscent of smooth muscle to pleomorphic sarcoma. Epithelioid features may be present. Most tumors are immunoreactive with antibodies to vimentin and actin, and reactivity with antikeratin antibodies does not exclude the diagnosis of leiomyosarcoma. Prostate leiomyosarcoma has a poor prognosis, although the length of survival is variable. Radical surgery was the treatment of choice in the current series, but complete excision was difficult in most cases and did not result in cure.

Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up.

Sarcoma of the prostate is a rare malignancy that affects younger men and has a poorer prognosis in comparison with prostate cancer. Transrectal ultrasound (TRUS) and ultrasound-guided biopsy of the prostate are the main methods for early diagnosis. Treatment of prostate sarcoma consists of radical surgery, chemotherapy, and radiotherapy. Absence of metastasis at the time of diagnosis and negative surgical margins are more important for prognosis than tumor size, grade, and histologic subtype.

The diagnosis of soft tissue tumors based on small tissue samples may be difficult. We report on an organ confined prostate sarcoma in an adult primarily diagnosed in a small piece of tissue, which spontaneously passed the urethra during voiding.

A patient with a history of pelvic radiation therapy for seminoma presented with a prostatic tumor, which appeared predominantly of high signal intensity on T2-weighted magnetic resonance images; low-signal-intensity tissue also extended to the pelvic sidewall. At surgical pathology, the tumor was determined to be radiation-induced sarcoma of the prostate, and the extraprostatic tissue was postradiation fibrosis.

A patient with sarcoma of the prostate was treated with radical prostatectomy including wide excision of the ipsilateral neurovascular bundle and hemicystectomy. Six years postoperatively he is free of disease, continent with a bladder capacity of 350 cc, voids to completion, and is potent.

9557 Background: Chemoresistant relapsing prostate sarcoma has no standard treatment and the prognosis is extremely poor. Imatinib mesylate may target on tyrosine kinases of platelet-derived growth factor receptor (PDGFR) which has been shown to be important in tumor growth of certain types of soft tissue sarcoma. Thalidomide, itself a potent immunomodulatory agent has exhibited clinical activity in several malignant neoplasms which have been linked to abnormal angiogenesis and tumor vasculature. Case Report: A 38-year-old man who underwent radical cystoprostatectomy in June 2004 for a stage III high-grade soft tissue sarcoma of spindle and round cell type of prostate staged pT2b(8cm) pN0(0/26) M0, received adjuvant radiotherapy up to 6,660 cGy/37Fx postoperatively. Immunohistochemistry study showed vimentin+, CD34+, CD117−, desmin+, SMActind- and S-100−. Distant relapse in lungs was noted in April 2005. Shortly later massive pleural effusion developed. Three cycles of salvage chemotherapy with MAID were given. Tumor assessment disclosed Progressive Disease status and metastatic tumors were chemoresistant. Imatinib mesylate 400 mg once a day plus thalidomide with increment dose to 200 mg/day was chosen as biologic treatment for his devastating condition after an informed consent was obtained. PDGFR immunohistochemistry staining of the paraffin block and gene sequencing are planned. Results: Marked tumor regression reaching very good partial remission and resolution of pleural effusion without recurrence. Dramatic improvement in terms of performance status and cancer-associated symptoms are obvious. Except for skin changes and mild periorbital edema from imatinib, no other significant adverse reactions were noted. Postulated mechanism of action may suggest PDGFR tyrosine kinase inhibition as well as antiangiogenesis. Conclusions: We documented a case of undifferentiated sarcoma of prostate with pulmonary metastases which were refractory to MAID chemotherapy but subsequently regressed on a combination of double biologic agents, imatinib mesylate plus thalidomide. No significant financial relationships to disclose.

A 19-year-old student who had presented with acute urinary retention was referred to our hospital with biopsy diagnosis of proliferating mesenchymal tumor of the prostate. Magnetic resonance imaging showed enlarged prostatic masses. Suspecting prostate sarcoma, we performed a nerve-sparing radical prostatectomy. Histologic diagnosis of the tumor was prostatic malignant phyllodes tumor. Five months after the operation, bilateral obturator lymph node metastases appeared, which were treated with etoposide, ifosfamide, and cisplatin chemotherapy. After a good response was achieved with four cycles of the chemotherapy, pelvic irradiation was added. Since then, there has been no evidence of recurrence for more than 4 years.

Prostate sarcomas are rare but aggressive neoplasms presenting unique therapeutic challenges. We report a case of prostate sarcoma, and discuss disease control and preservation of quality of life. CASE REPORT A 51-year-old healthy male with normal prostate specific antigen was referred to our institution for evaluation of an asymmetrically enlarged nodular prostate and progressive obstructive voiding symptoms. Transrectal ultrasound revealed a multilocular cystic mass replacing the left side of the prostate (fig. 1, A). Pathological examination of the biopsy cores and subsequent chips from transurethral resection of the prostate for acute urinary retention revealed an indeterminate subtype of prostatic sarcoma. Further diagnostic evaluation included pelvic magnetic resonance imaging which demonstrated a complex multilocular solid mass of the left peripheral prostatic lobe displacing the seminal vesicles but without evidence of local invasion (fig. 1, B). Computerized tomography of the chest, abdomen, pelvis and brain, bone scan and fluorodeoxyglucose whole body tumor scan revealed no evidence of metastatic disease. The patient subsequently elected to undergo radical cystoprostatectomy with unilateral sparing of the neurovascular bundle and continent urinary diversion. Pathological examination of the cystoprostatectomy specimen revealed 5 5.5 cm. high grade prostatic sarcoma with focal chondroid differentiation arising from the left prostatic lobe. All surgical margins were negative. The patient presented with bloody urethral discharge 2 months postoperatively. Urethroscopy and biopsy revealed recurrent sarcoma at the level of the external urethral sphincter. Repeat computerized tomography further demonstrated interval development of multiple bilateral pulmonary nodules. The patient was subsequently started on systemic chemotherapy with dacarbazine, ifosfamide, doxorubicin and mesna. DISCUSSION