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Adult Prostate Sarcoma: Demographics, Treatment Patterns, and Survival - Beyond the Abstract

Acinar adenocarcinoma represents the dominant histological type of prostate cancer.1,2 Conversely, non-epithelial malignancies are extremely rare tumor entities with unfavorable survival outcomes.3,4  Literature addressing adult prostate sarcoma patients is scarce. Most reports describe single-institutional series that rely on small samples and historic patient cohorts.5–9 Therefore, further investigations are necessary to improve diagnostic precision and therapeutic outcomes in this rare but challenging malignancy.

Among more than 860.000 prostate cancer patients, a novel population-based study identified only 125 adult prostate sarcomas within the Surveillance, Epidemiology and End Results (SEER) database over a study period of seventeen years (2004-2020). Within this study, Siech et al. addressed disease stage at presentation, treatment patterns as well as survival outcomes in adult prostate sarcoma patients according to histologic subtypes. Specifically, this contemporary study sheds light on the complex clinical behavior of prostate sarcomas, offering crucial data that can guide both oncologists as well as urologists to more tailored, histology-specific treatment strategies for such aggressive disease.

Key Findings:

  • Among adults, leiomyosarcoma (36%) represents the most common histological subtype of prostate sarcoma, followed by rhabdomyosarcoma (14%), sarcoma not otherwise specified (NOS; 14%), and stromal sarcoma (12%).
  • The majority of rhabdomyosarcoma patients received a combination of systemic and radiation therapy with (24%) or without radical surgery (35%). Conversely, most leiomyosarcoma and stromal sarcoma patients were treated with radical surgery with (22 and 13%) or without (22 and 47%) radiation.
  • Within the study cohort, median overall survival was only 27 months. The 5-years cancer-specific mortality rate was 58% and 5-years other-cause mortality rate was 13%.
  • In multivariable Cox regression models, stromal sarcoma was the only histologic subtype associated with lower overall mortality (HR 0.41; p = 0.039).
  • Clinical Implications and Conclusions
  • In conclusion, the current report may help clinicians caring for prostate sarcoma patients to predict their treated natural history better. Moreover, the findings of this contemporary population-based study may be beneficial in clinical decision-making since treatment patterns of prostate sarcoma patients vary according to histological subtype and stage at presentation, from multimodal therapy to radical prostatectomy alone. These treatment differences reflect equally important heterogeneity in survival patterns.
Written by: Carolin Siech, MD, Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada

References:

  1. Netto GJ, Amin MB, Berney DM, Compérat EM, Gill AJ, Hartmann A, et al. The 2022 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs—Part B: Prostate and Urinary Tract Tumors. European Urology. 1 novembre 2022;82(5):469–82.
  2. Siech C, de Angelis M, Jannello LMI, Di Bello F, Rodriguez Peñaranda N, Goyal JA, et al. Rare histological prostate cancer subtypes: Cancer-specific and other-cause mortality. Prostate Cancer and Prostatic Diseases [Internet]. 10 luglio 2024;
  3. Siech C, de Angelis M, Di Bello F, Rodriguez Peñaranda N, Goyal JA, Tian Z, et al. Adult Prostate Sarcoma: Demographics, Treatment Patterns, and Survival. Annals of Surgical Oncology [Internet]. 23 settembre 2024;
  4. De Bari B, Stish B, Ball MW, Habboush Y, Sargos P, Krengli M, et al. Adult prostatic sarcoma: A contemporary multicenter Rare Cancer Network study. The Prostate. 1 luglio 2017;77(10):1160–6.
  5. Ball MW, Sundi D, Reese AC, Meyer CF, Terezakis SA, Efron JE, et al. Multimodal Therapy in the Treatment of Prostate Sarcoma: The Johns Hopkins Experience. Clinical Genitourinary Cancer. 1 ottobre 2015;13(5):435–40.
  6. Dotan ZA, Tal R, Golijanin D, Snyder ME, Antonescu C, Brennan MF, et al. Adult Genitourinary Sarcoma: The 25-Year Memorial Sloan-Kettering Experience. The Journal of Urology. 1 novembre 2006;176(5):2033–9.
  7. Janet NL, May AW, Akins RS. Sarcoma of the Prostate: A Single Institutional Review. American Journal of Clinical Oncology [Internet]. 2009;32(1).
  8. Musser JE, Assel M, Mashni JW, Sjoberg DD, Russo P. Adult Prostate Sarcoma: The Memorial Sloan Kettering Experience. Urology. 1 settembre 2014;84(3):624–8.
  9. Sexton Wade J., Lance Raymond E., Reyes Adriana o., Pisters Peter W.T., Tu Shi-Ming, Pisters Louis L. Adult Prostate Sarcoma: The M. D. Anderson Cancer Center Experience. Journal of Urology. 1 agosto 2001;166(2):521–5.
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