Squamous cell carcinoma of the prostate: long-term survival after combined chemo-radiation

Abstract

Background: Carcinoma of the prostate gland is the most frequent malignant tumour affecting male population. While the large majority of tumours is represented by adenocarcinoma, pure squamous cell carcinoma comprises only 0.5-1% of all prostate neoplastic lesions. It is characterised by a high degree of malignancy, commonly metastasising to the bone (mainly with osteolytic lesions), liver and lungs with a median survival time of 14 months. Several therapeutic approaches have been employed in the effort to treat prostate pure squamous cell carcinoma, including radical surgery, radiotherapy, chemotherapy and hormonal therapy. All of them mostly failed to gain a significant survival benefit.

Case report: We herein report on a case of pure squamous cell carcinoma of the prostate approached with combined-modality treatment, with the administration of 3 courses of cisplatin 75 mg/m(2) on day 1 and continuous infusion 5-fluorouracil 750 mg/m2 on day 1 to 5 and, subsequently, radiotherapy, with the delivery of a total dose of 46 Gy to the whole pelvis, with additional boost doses of 20 Gy to the prostatic bed and adjunctive 6 Gy to the prostate gland (72 Gy in total). The patient remained free of disease for 5 years, finally experiencing local relapse and, subsequently, dying of acute renal failure due to bilateral uretero-hydro-nephrosis. In addition, we provide a complete overview of all reported cases available within the medical literature.

Conclusion: Since it remains questionable which should be the most appropriate therapeutic approach towards prostate pure squamous cell carcinoma, our report demonstrates that a prolonged disease control, with a consistent survival time, may be achieved by the combination of an effective local treatment such as radiotherapy with systemic infusion of chemotherapeutic drugs.

Figure 1

Hematoxilin and eosin-stained sections showing solid sheets of squamous cells infiltrating the right lobe of the prostate (a; original magnification 10×) and the left lobe (b, c; original magnification 10× and 20×, respectively). Mytotic activity may also be observed (d; original magnification 40×).

Figure 2

Immunohistochemistry showed negativity to cytokeratin 7 (a; original magnification 10×) and cytokeratin 20 (b; original magnification 40×). Squamous carcinoma cells also stained negative for PSA and PAP, while adjacent remaining glands stained positive (c, d; original magnification 40×).