Radiation-Induced Leiomyosarcoma of the Prostate after Brachytherapy for Prostatic Adenocarcinoma

Abstract

Radiation therapy (RTx) has been employed as a curative therapy for prostatic adenocarcinoma. RTx-induced sarcomas (RISs) are rare, late adverse events, representing less than 0.2% of all irradiated patients. RISs are more aggressive tumors than prostatic adenocarcinomas. Herein, we present a case with RTx-induced prostatic leiomyosarcoma after permanent brachytherapy for prostatic adenocarcinoma. A 69-year-old male presented with dysuria and gross hematuria. Six years previously, he had been diagnosed with localized prostate cancer and was treated by permanent brachytherapy. Urethroscopy showed stenosis by a tumor at the prostate. Transurethral prostatectomy was performed for a diagnosis. Based on pathological findings, the diagnosis was leiomyosarcoma of the prostate. He was treated with three cycles of neoadjuvant chemotherapy (CTx) that consisted of doxorubicin and ifosfamide (AI), followed by a prostatocystectomy with intrapelvic lymphadenectomy. The tumor extended from the prostate and infiltrated the bladder wall and serosa with lymphatic and venous invasion. The surgical margin was negative, and no residual prostatic adenocarcinoma was observed. The proportion of necrotic tumor cells by neoadjuvant CTx was around 50%. Subsequently, adjuvant CTx was offered, but the patient chose a follow-up without CTx. Local recurrence and lung metastasis were detected by computed tomography 3 months after the surgery. He was treated again with AI. However, CTx was not effective and he died 6 months after the operation. In conclusion, an effective treatment strategy for prostatic sarcoma should be developed in the near future, although the clinical feature of prostatic sarcoma remains unclear due to its rare incidence.

miR-1207-3p regulates the androgen receptor in prostate cancer via FNDC1/fibronectin

“…48 4343 Prostate leiomyosarcoma is a mesenchymal tumor that is particularly rare, highly aggressive, and accounts for less than 3.7% of primary prostate diseases. 48,49 To our knowledge, this study is the first to demonstrate microRNA regulation of FNDC1. Also, to our knowledge, only two miRNAs has been shown to directly target a member of the FN1 family in PCa, miRs-143 and-145.…”

Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

“…Surgical margins were negative for tumor cells by this approach, but it was very close (<1 mm). There have been some reports on the effectiveness of radiotherapy against local recurrence [6, 13, 14], while radiotherapy was reported to be a risk factor for LMS [15]. Adjuvant radiotherapy or chemotherapy was not performed because there is no established adjuvant therapy for rectal LMS and the elderly patient did not hope to receive adjuvant therapies.…”

A Review of the Literature on Primary Leiomyosarcoma of the Prostate Gland

“…Treatment . Treatment options that can be undertaken in cases of leiomyosarcoma of the prostate gland include the following: Radical surgery in the form of radical prostatectomy or exenteration alone or plus or minus chemotherapy alone or plus radiotherapy (see, e.g., [ 15 , 28 ]). Chemotherapy and radiotherapy (see, e.g., [ 29 ]).…”

“…Radical surgery in the form of radical prostatectomy or exenteration alone or plus or minus chemotherapy alone or plus radiotherapy (see, e.g., [ 15 , 28 ]).…”

“…Horiguchi et al [ 28 ] reported a 69-year-old man who had been diagnosed as having adenocarcinoma of prostate gland and who had been treated by means of brachytherapy. Six years after he had undergone brachytherapy, he developed dysuria and visible haematuria.…”