PROSTATIC SARCOMA WITH RAPID TUMOR PROGRESSION AFTER NERVE SPARING RADICAL CYSTOPROSTATECTOMY

Abstract

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