| disease | Prostate Fleshy Tumor |
Prostate sarcoma is extremely rare and is a type of malignant tumor occurring in the stromal tissue of the prostate. It accounts for 0.1% of prostate malignancies and originates from mesodermal tissue, differentiating into various types of sarcomas. Common types include rhabdomyosarcoma, leiomyosarcoma, and fibrosarcoma, while others such as lymphosarcoma, myxosarcoma, angiosarcoma, and chondrosarcoma are relatively rare. Rhabdomyosarcoma is more common in children, whereas leiomyosarcoma is more frequently seen in adults. Prostate sarcoma is a rare malignant tumor of the prostate, representing 2.7%–7.5% of prostate malignancies in China and 0.1%–0.3% in Western developed countries. This difference may be attributed to the higher proportion of prostate cancer in Western nations and the lower incidence of prostate cancer in China. It predominantly occurs in children, grows rapidly, and has a very poor prognosis. The main symptoms include difficulty urinating and urinary retention. Digital rectal examination reveals a significantly enlarged prostate with a smooth and soft surface. Early-stage treatment involves prostatectomy, while advanced cases may only undergo bladder fistula surgery, supplemented with radiotherapy and chemotherapy. Although the incidence of this disease is low, the tumor grows aggressively, and the prognosis is unfavorable, warranting high clinical attention.
bubble_chart Etiology
Prostate fleshy tumors are commonly found in children. In children, prostatic fleshy tumors are often very large, frequently surrounding the bladder neck and even filling the entire pelvic cavity. Due to the rapid growth of fleshy tumors, the tumor mass may undergo hemorrhage, necrosis, or degenerative changes. The tumor typically appears oval-shaped and has a soft, flexible texture. If it occurs in elderly individuals, the tumor constitution tends to be harder.
Under microscopic examination, striated muscle fleshy tumors can exhibit different cell types. The cells may be small and round or relatively large, with striations and marginal vacuoles. The cells can also be elongated, containing longitudinally arranged nuclei. The tumor often contains mucinous edema and poorly differentiated cells, with active mitotic activity.Smooth muscle fleshy tumor cells are elongated with blunt-ended nuclei.
bubble_chart Clinical Manifestations
The growth rate of a prostate fleshy tumor is rapid, often manifesting as frequent urination, painful urination, difficulty urinating, and hematuria. This is caused by the tumor compressing the bladder and urethra. If the tumor infiltrates the rectum, it can lead to difficulty in defecation. If it compresses the ureters, it may cause hydronephrosis and urinary tract infections. If it compresses veins, lymphatic vessels, or nerves, it can result in lower limb edema and pain.
Prostate fleshy tumors frequently occur in young individuals. If a young person suddenly develops the aforementioned symptoms, this condition should be suspected. During a digital rectal examination of a patient with a prostate fleshy tumor, an enlarged prostate may be palpated—soft yet elastic, possibly with a fluctuating sensation, smooth on the surface, or with discernible lobes or nodules. It should be differentiated from prostate cysts and prostate abscesses. Bladder urethrography can reveal urethral displacement, elevation of the bladder base, and reduced capacity.
Approximately 40% of prostate fleshy tumors may metastasize distantly. For instance, X-ray imaging may detect metastatic lesions in the bones and lungs.
Prostate fleshy tumor is a malignant disease with a poor prognosis, and mastering its treatment principles is crucial.
When the prostate fleshy tumor is confined within the prostate membrane and has not yet infiltrated outward, surgical treatment should be performed as early as possible, with radical bladder prostatectomy.
If the tumor has only locally extended to the bladder or rectum without distant metastasis, total pelvic organ resection may be considered, but this method often yields unsatisfactory results. Extensive surgery may accelerate the spread of tumor cells.
For patients who cannot undergo surgery, radiation therapy is only sensitive to a few cases of lymphatic fleshy tumor and reticular cell fleshy tumor, and it may also provide some benefit for smooth muscle fleshy tumor. Some believe that radiation therapy for rhabdomyosarcoma may instead promote tumor progression.
For pediatric patients, chemotherapy should be initiated first after a definitive diagnosis, using the VAC regimen (vincristine, actinomycin D, and cyclophosphamide), followed by surgical resection. Most children require bladder resection and urinary diversion, but every effort should be made to preserve the rectum. In recent years, some have suggested that pediatric patients may undergo chemotherapy first, followed by radiation therapy, and then bladder-sparing surgery.
Currently, the best treatment regimen for pediatric patients is preoperative chemotherapy, surgical resection, postoperative radiation therapy (if tumor remnants are present), and periodic preventive chemotherapy. This regimen has led to remarkable improvements in the prognosis of pediatric patients.
The prognosis is often poor, especially for pediatric patients, with most cases surviving no more than one year after a definitive diagnosis. Rhabdomyosarcoma is highly malignant and grows the fastest, with almost all patients dying within a year. Leiomyosarcoma and fibrosarcoma grow more slowly and have a slightly better prognosis, with an average survival of 2–3 years.
In infants and young children, prostatic sarcoma develops and metastasizes more rapidly and extensively than in adults. From the onset of symptoms to death, the average survival time is 3 months for children under 10 years old, compared to about 1 year for adults. In recent years, the prognosis for childhood rhabdomyosarcoma has improved due to the adoption of surgical, radiation, and chemotherapy treatments. For localized disease, a 2-year course of chemotherapy following surgery can achieve a tumor-free survival rate of 54% in children. This progress offers hope.
