Sarcomatoid Carcinoma (Carcinosarcoma) of the Prostate Gland: A Review of the Literature

Abstract

Background: Adenocarcinomas of the prostate gland are commonly encountered globally but other uncommon variants of carcinoma of the prostate are sporadically encountered including primary sarcomatoid carcinoma of the prostate (PSCP). Aims: To review the literature of PSCP. Methods: Various internet search engines were searched for literature on PSCP. Literature Review: About 100 cases of PSCP have so far been reported. PSCP may develop de novo or may emanate following hormonal treatment or radiotherapy for adenocarcinoma of prostate; PSCP may present with LUTS, haematuria, perineal/back pain. Histology of prostate biopsy tends to show a biphasic tumour which has an adenocarcinoma component as well as a second component which is a clearly recognizable type of sarcoma component which could be angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma or rhabdomyosarcoma. With regard to immunohistochemistry Immunohistochemistry, the epithelial component of sarcomatoid carcinoma of prostate stains positively for cytokeratin and PAP, and negatively for PSA; the sarcoma component stains negatively for PSA, EMA and keratin. There is no consensus opinion on treatment. TURP has been performed for lower urinary tract obstruction symptoms and urinary retention, radical prostatectomy, pelvic exenteration, and chemotherapy are some of the treatments employed. A number of cases of PSCP had presented at advanced stages of the disease. PCSP is aggressive with poor prognosis; however, early aggressive surgery in some cases had resulted in survival.  Conclusions: A multi-centre trial is required to determine the best treatment option for PSCP. Perhaps patients with progressing prostate cancer following radiotherapy of castrate resistant prostate cancer should have repeat prostate biopsies to determine if they have developed dedifferentiation into PSCP or other variants of prostate cancer and to try cases of PSCP on chemotherapy as a trial.