The natural history, treatment, and survival of 199 patients with sarcomatoid carcinoma of the prostate.

278 Background: Sarcomatoid carcinoma of the prostate (SCP) is a rare and aggressive subtype of prostate cancer. Current data on clinical features, appropriate management and long-term outcomes of SCP are limited. Methods: A systematic review of literature was performed to identify published reports on SCP using keywords “sarcomatoid”, “prostate”, and “carcinosarcoma”. No randomized trials were identified. Four single-center case series and one registry-based study were included in final analysis. Results: In total, 199 patients were included in the review (54 from the SEER registry, 145 from the four case series). SCP occurs more frequently in the late sixth to seventh decade of life (age range: 28-91 years). Many patients with SCP (range, 48%-78%) have a history of prostate adenocarcinoma, with variable time to SPC onset (range, 0.5-20 years). Most tumors are high grade, with locally advanced or distant stage. Urinary obstruction was the most common symptom (50%-92%). Advanced stage was associated with poor prognosis in all reports. Although prostatectomy as part of multimodality treatment likely affected cancer-specific survival in select patients, large variation was observed in prostatectomy and adjuvant therapy rates. No effective systemic chemotherapy was reported. Conclusions: SCP is an aggressive variant of prostate adenocarcinoma. Molecular studies are needed to illuminate their aggressive underlying biology and develop individualized therapeutic approaches. The results of this analysis may help increase awareness of this rare malignancy and serve as a baseline for future clinical studies. [Table: see text]