Favorable Response to Neoadjuvant Chemotherapy and Radiation in a Patient With Prostatic Stromal Sarcoma

Abstract

A 66-year-old African American man initially presented to his local urologist with obstructive lower urinary tract symptoms.Digital rectal examination was performed and revealed an enlarged prostate without palpable nodules.The serum prostate-specific antigen concentration was 3.5 ng/mL.A transrectal, ultrasound-guided prostate biopsy was negative for cancer.The obstructive urinary symptoms of the patient were managed with tamsulosin and finasteride, and his prostate-specific antigen remained stable over the next several years.Six years later, the patient developed acute urinary retention for which a Foley catheter was placed.A computed tomography (CT) scan of the abdomen and pelvis revealed a 9 ϫ 10 ϫ 8-cm prostatic mass protruding into the bladder (Fig 1).A repeat prostate biopsy was not performed.The local urologist of the patient suspected a bladder outlet obstruction from benign prostatic hyperplasia and recommended a robotic-assisted suprapubic prostatectomy.A subtotal prostatectomy was performed robotically.Pathology from this resection revealed a high-grade (grade 3 of 3) prostatic stromal sarcoma with positive surgical margins.The prostate specimen weighed 154 g.The patient was referred to our institution for additional management.Cross-sectional imaging revealed persistent prostatic enlargement but no evidence of distant disease.Because of the incompletely resected sarcoma and violation of the tumor capsule, an aggressive management strategy including neoadjuvant chemotherapy and radiation followed by radical cystoprostatectomy was recommended.The patient received two cycles of neoadjuvant ifosfamide and adriamycin followed by 50 Gy of intensity-modulated radiation therapy.Follow-up CT of the abdomen and pelvis revealed a