Iwahashi et al. reported the first experience of diagnosing and treating undifferentiated pleomorphic sarcoma (UPS) of the prostate in a 27‐year‐old man. 1 UPS is a highly malignant disease and is extremely rare in younger people and in the prostate. Therefore, this is an educative case report that is valuable in finding clues for the treatment of this rare condition.
For metastatic soft tissue sarcoma (STS) chemotherapy, doxorubicin monotherapy or combination therapy with ifosfamide or olaratumab is likely to be used as the first line. Trabectedin, gemcitabine‐docetaxel, and pazopanib are also used in cases of advanced cancer. 2 However, the prognosis of advanced UPS is poorer than that of other histologic subtypes of STS. Recently, immune checkpoint inhibitors have been receiving increased attention in the treatment of malignant neoplasms. Phase II trials of nivolumab and ipilimumab combination therapy for patients with metastatic STS, including 14% with UPS, reported a confirmed response rate of 16% and overall survival of 14.3 months. 3 High levels of T‐cell infiltration and PD‐L1 expression were described in UPS compared with that of other histologic subtypes of STS. 4 It is expected that future research will reveal the efficacy of immune checkpoint inhibitors for the treatment of UPS.
The efficacy of adjuvant/neoadjuvant chemotherapy and radiotherapy focused on histological UPS or prostate sarcomas has not been demonstrated. Therefore, surgery remains the cornerstone of treatment in nonmetastatic UPS. In this report, the tumor recurred at the front of the rectum despite the resected margin having been negative. Moreover, the occurrence of multiple liver metastases is more common in rectal than prostate cancers. I am interested in a potential causal relationship between transrectal biopsy and tumor recurrence in prostate sarcomas. The biopsy tract and scar should be removed at the time of definitive surgery to prevent recurrence from tumor seeding in STS. 5 If needle biopsy increases the risk of local recurrence, total pelvic exenteration may be recommended in prostate sarcomas diagnosed by transrectal biopsy.
Conflict of interest
The author declares no conflict of interest.
References
- 1. Iwahashi Y, Matsumura N, Kusumoto H et al Undifferentiated pleomorphic sarcoma of the prostate in a young man. IJU Case Rep. 2020; 3: 145–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Widemann BC, Italiano A. Biology and management of undifferentiated pleomorphic sarcoma, myxofibrosarcoma, and malignant peripheral nerve sheath tumors: State of the art and perspectives. J. Clin. Oncol. 2018; 36: 160–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. D'Angelo SP, Mahoney MR, Van Tine BA et al Nivolumab with or without ipilimumab treatment for metastatic sarcoma (Alliance A091401): two open‐label, non‐comparative, randomised, phase 2 trials. Lancet Oncol. 2018; 19: 416–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Pollack SM, He Q, Yearley JH et al T‐cell infiltration and clonality correlate with programmed cell death protein 1 and programmed death‐ligand 1 expression in patients with soft tissue sarcomas. Cancer 2017; 123: 3291–304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Garcia del Muro X, de Alava E, Artigas V et al Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS). Cancer Chemother. Pharmacol. 2016; 77: 133–46. [DOI] [PMC free article] [PubMed] [Google Scholar]