A rare case of leiomyosarcoma of the prostate: Treatment and review of literature

Abstract

Leiomyosarcoma is most common in adults and constitutes 38%–52% of primary prostatic sarcomas. Primary prostatic leiomyosarcoma is extremely rare which accounts for 0.1% of all prostatic malignancies. Patients present with signs and symptoms generally encountered with prostatic enlargement. A 41-year-old gentleman presented with complaints of burning micturition and difficulty in passing urine and stools for 1 month. Magnetic resonance imaging of the pelvis showed a 10 cm × 5.6 cm × 5.9 cm heterogeneous mass lesion originating from the prostate gland extending into bilateral seminal vesicles. There is loss of fat planes with bladder, rectum, and rectosigmoid. Transrectal ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis as leiomyosarcoma of the prostate. Because of the proximity of the prostate with urinary bladder and difficulty in resection, the patient received neoadjuvant stereotactic body radiotherapy (SBRT) to a dose of 30 Gy in 5 fractions alternate day over a period of 2 weeks. The patient underwent cystoscopy, followed by radical prostatectomy 1 month post-SBRT. Histopathological examination of the prostatectomy specimen was suggestive of high-grade spindle cell neoplasm. The margins were focally involved by the tumor. Because of positive margins, the patient underwent adjuvant radiation treatment to postoperative primary tumor bed to a dose of 30 Gy in 15 fractions by conventional fractionation on Halcyon 2.0. The patient tolerated the treatment well with minimal side effects. The patient is symptom-free and disease-free 3 months posttreatment and needs regular and long follow-up.

Keywords

• leiomyosarcoma
• prostatectomy
• stereotactic body radiotherapy