Sarcomatoid Carcinoma of the Prostate: Retrospective Review of a Case Series From the Johns Hopkins Hospital

Abstract

Objective: To identify survival differences in patients with sarcomatoid prostate cancer based on initial staging and treatment regimens.

Methods: We retrospectively reviewed the clinical outcomes of patients with a pathologically confirmed diagnosis of sarcomatoid prostate cancer. The primary statistical objective was to estimate overall survival (OS) and to assess the survival of patients at different stages treated with local and/or systemic approaches.

Results: We identified 70 transurethral resections, needle biopsies, or prostatectomy specimens that were reviewed by the Department of Pathology at the Johns Hopkins Hospital from 2002-2012 and given the diagnosis of sarcomatoid prostate cancer. Of the 45 patients with available survival data, complete medical histories were obtained for 27 patients who were stratified based on a modified staging system (local disease, local disease with bladder invasion, and metastatic disease). After a median follow-up of 106 months, the median OS of patients in the local disease group was not reached. Notably, 5 of the 9 patients diagnosed with local disease survived >5 years and were treated with surgery and/or external beam radiation therapy. The OS hazard was significantly increased in patients with either clinical evidence of bladder invasion (HR: 20.46 [95% CI: 2.43,172]; P = 0.005) or metastatic disease (HR: 43.34 [95% CI: 4.39,427.4]; P = 0.001), which both demonstrated poor outcomes (median OS: local disease with bladder invasion-9 months; metastatic disease-7.1 months).

Conclusion: This retrospective analysis suggests that local sarcomatoid prostate cancer can be effectively treated with definitive therapy leading to favorable outcomes.

FIGURE 1. Overall Survival of Patients with Sarcomatoid Prostate Cancer

A. Kaplan Meier estimate of overall survival in all patients with sarcomatoid prostate cancer. The median overall survival was 10.64 months with a subset of patients having prolonged survival. B. Kaplan Meier estimate of overall survival in sarcomatoid prostate cancer patients stratified by a modified staging system. Median OS – local disease: not reached; local with bladder invasion: 9 months; metastatic disease: 7.1 months; unstaged: 1.28 months.

FIGURE 2. Treatment Paradigms and Outcomes of Patients with Advanced Disease

A. Fifteen patients were identified with advanced disease. Four of the 15 patients were treated with androgen deprivation therapy with a median survival of 7.85 months (HR 1.51, p = 0.52). Non-hormonal based therapies, used in 11 of 15 patients, led to a median survival of 9 months. B. Patients with advanced disease were grouped based on stage (local disease with bladder invasion and metastatic disease). Treatment paradigms including various chemotherapy regimens are indicated in each column.