Leiomyosarcoma of Prostate: A Case Report and Literature Review

Abstract

Prostate leiomyosarcoma is an extremely rare and very aggressive neoplasm that represents less than 0.1% of primary malignant tumors of the prostate. We present a patient with primary leiomyosarcoma of prostate and examine the cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this rare tumor. Median survival was estimated at 17 months (95% CI 20.7–43.7 months) and the actuarial survival rates at 1, 3 and 5 years were 68%, 34% and 26%, respectively. The only predictors of long-term survival were negative surgical margins and the absence of metastatic disease at presentation. A multidisciplinary approach is necessary for the proper management of this terrible entity.
 Surgery with or without chemotherapy seems to be the main therapeutic method for operable leimyosarcomas, but in general there is no consensus on the best therapeutic approach. Most cases are diagnosed at an advanced stage of the disease. A global multicenter trial is needed to find therapies that would improve the prognosis.

Primary leiomyosarcoma of prostate: Report of 3 cases

“…Heddat et al 7 in their study stated that the most frequent reason for consultation is a urinary obstructive syndrome including hematuria, burning with urination, perineal pain, urgency, acute urine retention and weight loss as observed in our case. 3,[6][7][8][9] Patients typically present between the ages of 41 and 78 years (mean age 61 years). 1,10 Serum PSA levels are typically normal due to their nonepithelial origin, making it highly difficult to differentiate these from benign prostatic diseases.…”

“…5,9,11 Abdominopelvic ultrasound would reveal hydronephrosis, thickening of the bladder wall or infiltration of the base of the bladder. 7,12 Transrectal prostate ultrasound is a useful technique to better assess the characteristics of the prostate. It can show heterogeneous hypoechogenic lesions in the prostate, an invasion of the capsule or an extension in the rectum, the pelvic sidewall, the seminal vesicle, or the ejaculatory duct.…”

“…It can show heterogeneous hypoechogenic lesions in the prostate, an invasion of the capsule or an extension in the rectum, the pelvic sidewall, the seminal vesicle, or the ejaculatory duct. 7,12,13 Echoguided transrectal biopsy tends to be the usual approach to obtain samples of the prostate lesion for the histological examination which would establish the diagnosis of leiomyosarcoma of the prostate. 7,12 Transurethral resection of the prostate for symptoms of the lower urinary tract or retention of urine may lead to the accidental diagnosis of leiomyosarcoma during the histological examination of the resection coupons.…”

“…7,12,13 Echoguided transrectal biopsy tends to be the usual approach to obtain samples of the prostate lesion for the histological examination which would establish the diagnosis of leiomyosarcoma of the prostate. 7,12 Transurethral resection of the prostate for symptoms of the lower urinary tract or retention of urine may lead to the accidental diagnosis of leiomyosarcoma during the histological examination of the resection coupons. 7 Tumors range in size from 3 to 21 cm and are highly infiltrative.…”

“…7,12 Transurethral resection of the prostate for symptoms of the lower urinary tract or retention of urine may lead to the accidental diagnosis of leiomyosarcoma during the histological examination of the resection coupons. 7 Tumors range in size from 3 to 21 cm and are highly infiltrative. Gross examination in Zazzara et al 1 study reveals an ill-defined mass with fleshy to firm consistency and a tan-pink appearance with focal areas of haemorrhage, necrosis and/or cystic degeneration.…”