Sarcomatoid Carcinoma of the Prostate: Retrospective Review of a Case Series from the Johns Hopkins Hospital

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 (OS) and to assess the survival of patients at different stages treated with 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 the 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 for 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 OS of patients in the local disease group was not reached. Notably, 5 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 = 0.005) or metastatic disease (HR: 43.34 [95% CI: 4.39,427.4]; P = 0.001), which both demonstrated poor outcomes (median OS: local disease with bladder invasion - 9 months; metastatic disease - 7.1 months). Conclusion This retrospective analysis suggests that local sarcomatoid prostate cancer can be effectively treated with definitive therapy leading to favorable outcomes.