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 and assess the survival of patients at different stages treated with either 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 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 on 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 overall survival (OS) of patients in the local disease group was not reached. Notably, five 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 = < 0.0001) or metastatic disease (HR: 43.34 [95% CI: 4.39,427.4]; p = < 0.0001), which both demonstrated poor outcomes (median OS: local with bladder invasion - 9 months; metastatic disease - 7.1 months).
CONCLUSIONS - This retrospective analysis suggests that local sarcomatoid prostate cancer can be effectively treated with definitive therapy leading to favorable outcomes.
Urology. 2015 Jun 27. pii: S0090-4295(15)00597-X. doi: 10.1016/j.urology.2015.06.011. [Epub ahead of print]
Markowski MC1, Eisenberger M1, Zahurak M2, Epstein JI3, Paller C4.
1 Division of Medical Oncology, Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD.
2 Division of Biostatistics and Bioinformatics, The Johns Hopkins University, Baltimore, MD.
3 Department of Pathology, The Johns Hopkins University, Baltimore, MD.
4 Division of Medical Oncology, Sidney Kimmel Cancer Center, The Johns Hopkins University, Baltimore, MD.