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.
From the Department of Radiation Oncology, University of Miami, Miami, FL.
Reprints: Nguyen L. Janet, MD, Department of Radiation Oncology, University of Miami, 1475 NW 12th Avenue, Miami, FL 33136. E-mail: email@example.com.