Prostate Sarcoma: An Uncommon Diagnosis With Major Clinical Implications

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Prostate sarcomas are rare and aggressive malignancies.
• They often present with obstructive urinary symptoms and normal prostate-specific antigen (PSA) levels.
• This leads to diagnostic challenges due to clinical overlap with benign prostatic conditions.

Observation:

• A 71-year-old male presented with refractory severe lower urinary tract symptoms (LUTS).
• Initial transurethral resection of the prostate (TURP) and subsequent procedures failed to identify malignancy.
• Histopathology eventually revealed prostate leiomyosarcoma with local extension to the bladder and rectum.

Findings:

• The patient underwent total pelvic exenteration for a T4 leiomyosarcoma.
• Postoperative complications included hypovolemic shock and disseminated intravascular coagulation.
• The patient died 28 days post-surgery despite intensive care.

Implications:

• This case underscores the diagnostic difficulties associated with prostate sarcomas.
• It highlights the aggressive nature and limited treatment options for advanced disease.
• Emphasizes the critical need for early diagnosis and comprehensive multidisciplinary management.