The Impact of Radical Prostatectomy on the Survival of Patients with Carcinosarcoma of the Prostate
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Abstract
<b>Background:</b> The objective of this study was to evaluate the impact of radical prostatectomy on carcinosarcoma of the prostate. Methods: Patients diagnosed with carcinosarcoma of the prostate from 1977 through 2007 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Outcomes were examined with Kaplan-Meier survival analysis and Cox models. The association between clinical and demographic characteristics and survival of carcinosarcoma of the prostate was examined. <b>Results:</b> A total of fifty-four cases of histology confirmed carcinosarcoma of the prostate were identified. Median age of the patients was 74 years (range 28 - 94). Of the patients with a known tumor stage, all but one patient had a locally advanced or distant stage; all of the patients with known histology grade had poorly or undifferentiated histology. Twenty (37%) patients underwent transurethral resection only and Fourteen (25.9%) patients underwent radical prostatectomy. Eight (14%) patients received radiation therapy in combination with surgery. The median cancer specific survival was 16 months (95% CI 0 - 32 months). 1-, 3-, and 5- year cancer specific survival rate were 55.1%, 32.3% and 21.1%. In a multivariate analysis, radical prostatectomy was found to be a significant prognostic factor for cancer-specific survival. Conclusions: Carcinosarcoma of the prostate commonly occurs in older patients and associated with aggressive disease and poor prognosis. Radical prostatectomy is the only treatment modality that significantly improves survival. Emphasis on early diagnosis and detection and multimodality therapy of this disease is needed to improve the outcome for patients with this malignancy.
- M. P. Wick and P. E. Swanson, “Carcinosarcomas: Current Perspectives and a Historical Review of Nosological Concepts,” Seminars in Diagnostic Pathology, Vol. 10, No. 2, 1993, pp. 118-127.
- S. M. McGee, S. A. Boorjian and R. J. Karnes, “Carcinosarcoma of the Prostate Replacing the Entire Lower Genitourinary Tract,” Urology, Vol. 74, No. 3, 2009, pp. 540-541. doi:10.1016/j.urology.2009.04.057
- M. R. Wick, R. H. Young, R. Malvesta, D. S. Beebe, J. J. Hansen and L. P. Dehner, “Prostatic Carcinosarcomas: Clinical, Histologic and Immunohistochemicaldata on Two Cases with a Review of the Literature,” American Journal of Clinical Pathology, Vol. 92, No. 2, 1989, pp. 131-139.
- P. A. Dundore, J. C. Cheville, A. G. Nascimento, G. M. Farrow and D. G. Bostwick, “Carcinosarcoma of the Prostate: Report of 22 Cases,” Cancer, Vol. 76, No. 6, 1995, pp. 1035-1042.
- A. A. Renshaw and S. R. Granter, “Metastatic Sarcomatoid, and PSA- and PAP-Negative Prostatic Carcinoma: Diagnosis by Fine Needle Aspiration,” Diagnostic Cytopathology, Vol. 23, No. 3, 2000, pp. 199-201.
- N. Perez, M. Castillo, Y. Santos, D. Truan, R. Gutierrez, A. Franco, A. Palacin, J. A. Bombi , E. Campo and P. L. Fernandez, “Carcinosarcoma of the Prostate: Two Cases with Distinctive Morphologic and Immunohistochemical Findings,” Virchows Arch, Vol. 446, No. 5, 2005, pp. 511-516. doi:10.1007/s00428-005-1239-x
- D. E. Hansel and J. I. Epstein, “Sarcomatoid Carcinoma of the Prostate: A Study of 42 Cases,” American Journal of Surgical Pathology, Vol. 30, No. 10, 2006, pp. 1316-1321.
- V. S. Subramanian, M. Coburn and B. J. Miles, “Carcinosarcoma of the Prostate with Multiple Metastases: Case Report and Review of the Literature,” Urologic Oncology, Vol. 23, No. 3, 2005, pp. 181-183. doi:10.1016/j.urolonc.2004.11.010
- C. G. Rogers, A. Parwani, A. Tekes, M. P. Schoenberg and J. I. Epstein, “Carcinosarcoma of the Prostate with Urothelial and Squamous Components,” Journal of Urology, Vol. 173, No. 2, 2005, pp. 439-440. doi:10.1097/01.ju.0000149969.76999.7c
- T. Fukawa, K. Numata, M. Yamanaka, T. Miyamoto, Y. Kurokawa, H. O. Kanayama, S. Kagawa, M. Utsunomiya and M. Hirokawa, “Prostatic Carcinosarcoma: A Case Report and Review of Literature,” International Journal of Urology, Vol. 10, No. 2, 2003, pp. 108-113. doi:10.1046/j.1442-2042.2003.00574.x
- S. E. Canfield, T. H. Gans, P. Unger and S. J. Hall, “Postradiation Prostatic Sarcoma: De Novo Carcinogenesis or Dedifferentiation of Prostatic Adenocarcinoma?” Techniques in Urology, Vol. 7, No. 4, 2001, pp. 294-295.