Abstract
Primary prostate sarcoma (PPS) is a rare and aggressive disease, with treatment approaches varying based on the tumor's characteristics and the patient's clinical stage at presentation. Due to the low incidence and heterogeneity of this tumor, conducting prospective clinical trials is challenging, resulting in limited medical literature and the absence of clear urological guidelines. This study aims to evaluate the overall survival outcomes associated with surgical approach, radiation therapy, and chemotherapy for primary prostate sarcoma, using data from a national registry.
Data was obtained from the National Cancer Database (NCDB) from 2004 to 2020. Patients age ≥18 years who had prostate sarcoma were included in this study. Patients with other histology types or additional neoplasms different from primary prostate sarcoma were excluded. For the surgical intervention group patients were considered if they had “radical prostatectomy” or “prostatectomy with resection in continuity with other organs”, patients who had no surgery, focal therapy, TURP, or simple prostatectomy were considered as having no oncological surgical intervention group. Furthermore, radiation therapy or chemotherapy was evaluated. Statistical analysis was performed using SAS version 9.4. Kaplan-Meier tests were used to analyze survival and Log-rank tests to evaluate differences between groups. To determine the association between survival and clinical variables, an univariate logistic regression was performed.
A total of 257 patients were analyzed, the median age was 60 [45 - 70] years, PSA at diagnosis 1.8 [0.7 - 4.2] ng/mL, and 209 (81.3%) were white. At initial clinical staging, 168 (65.4%) had node-negative disease and 27 (10.5%) metastatic disease. Histologically 82 (31.9%) had leiomyosarcoma, 47 (18.3%) rhabdomyosarcoma, 40 (15.6%) carcinosarcoma, and 88 (34.2%) had another type of sarcoma or not reported. Overall, 114 (44.4%) received radiation therapy, and 114 (44.4) received chemotherapy. Regarding surgical intervention, 112 (43.6%) underwent prostate resection, and 138 (53.7%) had no oncological surgical intervention. During follow-up 79 (30.7%) patients were confirmed to be alive. Risk and survival analysis showed overall benefit in patients who underwent surgical intervention with oncologic intent (OR = 0.573, 95%CI: 0.330 - 0.994; p = 0.0475). Overall survival did not significantly differ between radiation or chemotherapy groups (Table 1 and Figure 1).
Primary prostate sarcoma is an aggressive disease with poor survival. Our data shows an overall survival benefit associated with surgical resection. In contrast, radiation therapy and chemotherapy show similar survival across the overall population. Although our findings should be interpreted thoughtfully due to the limitations inherent in analyzing data from a national oncology registry, we anticipate that future prospective studies will validate our results.