The Clinical And Prognosis Study Of Prostatic Malignant Mesenchymal Tumors (Report Of20Cases)

Objective and Background:Prostatic malignant mesenchymal tumors (PMMT) are various seldom seen malignant mesenchymal tumors in prostate, such as eiomyosarcoma, rhabdomyosarcoma, malignant fibrous histiotoma, osteosarcoma, chondrosarcoma and malignant peripheral nerve sheath tumor etc. Alought PMMT has wide varieties, but the over all morbidity is very low. The foreign reports shows Incidence of prostatic sarcoma account for0.10%-0.24%of malignant tumor of the prostate, and the China reports shows the incidence is2.7%-7.5%. The difference between these two data may result from a lower mobidity of prostate cancer in China. Because of the rapid progress of cancer and no noticeable symptoms at the early stage, combined with diffuse and transfer at local or body when seeing doctor and the varied clinical treatment which are not very effective, so in general the prognosis was poor. Many doctors have pay attention to this.Given all this, we collected and analyzed the clinic data of20people with cancer came to our hospital in last10years and reviewed literature at the same time in order to improve the diagnosis and treatment of the disease. Materials and methods:We collected the clinic data of20PMMT patients from First Affiliated Hospital, Medical School of Zhejiang University from2003.1-2013.1. We investigated medical history, phys exam, aboratory tests, color Doppler ultrasonography, CT, MRI, prostate biopsy, and the postoperative specimens were performed for histopathological and immunohistochemical examinations. The data will be contrasted and analysed by the survival analysis method (Kaplan-Meier). Survival curve will be drawed and the survival differences will be compared by Log-Rank test at the same time (statistical software with SPSS19.0). With all these data and the relative literature, we will explore the diagnosis, treatment and prognosis of PMMT here.Results:Based on pathology and immunohistochemistry, the20patients was confirmed PMMT of the prostate including leiomyosarcoma (n=7), rhabdomyosarcoma(n=5), prostatic stromal sarcoma(n=3), chondrosarcoma(n=1), and undifferentiated malignant mesenchymal tumors (n=4).13cases underwent radical prostatectomy, among them6cases underwent radiotherapy and chemotherapy before or after operation (including2cases of stage Ⅰ,3cases of stage Ⅱ,1case of stage Ⅲ);2cases underwent pelvic tumor resection (the arterial embolization have been performed preoperative),among them1case underwent chemotherapy after operation (including1case of stage Ⅱ,1case of stage Ⅲ);1patient underwent total pelvic exenteration(1case of stage Ⅱ),1patient (1/20) underwent pelvic lymph node biopsy and colostomy;3cases accepted conservative treatment because preoperative imaging showed metastasis of lung, pelvis and bone. In all patients,9cases (9/20) died of systemic metastasis3months later;3cases (3/20) died of tumor postoperatively at6,7and14months, respectively;3(3/20) survived with tumor for5,11and12months, respectively;2(2/20) kept alive for12and 24months so far, all accept postoperative periodic chemotherapy;3(3/20) was out of follow-up.Conclusions:In general the prognosis of PMMT was poor because of young age incidence, high malignancies and rapid progress. The diagnosis of PMMT is usually accomplished with transrectal ultrasound guided core biopsy and the ultimate diagnosis relies on pathology and immunohistochemistry. Clinical Stage was the important factor. Early Diagnosis and combined therapy dominated by radical prostate excision could improve the survival rate significantly.