Prostatic Carcinosarcoma With Lung Metastases
Stefanie R. FurlanAcademic Editor: Received
Abstract
Carcinosarcoma of the prostate is an uncommon malignancy with poor long-term prognosis. The cancer is typically discovered at an advanced stage, and with less than 100 reported cases, there is limited literature concerning treatment options. Our patient presented with a history of benign prostatic hypertrophy, erectile dysfunction, and nocturia. Biopsy of his prostate indicated that the patient had prostatic adenocarcinoma, but histopathology after prostatectomy revealed carcinosarcoma. It has been over six years since this patients diagnosis of carcinosarcoma. Over this span of time, he has received a radical prostatectomy, radiotherapy, and androgen ablative therapy. The patient also developed multiple lung metastases that have been treated with video-assisted thoracic surgery and stereotactic body radiosurgery. Overall, he has remained unimpaired and in good condition despite his aggressive form of cancer.
1. Introduction
2. Case Report
A 72-year-old male with a longstanding history of benign prostatic hypertrophy and erectile dysfunction initially presented with severe nocturia that had been present for several years. On digital rectal exam, a diffusely enlarged prostate with discrete nodularity and central induration was palpated. Prostate-specific antigen level was 2.9ng/dL . A subsequent biopsy revealed Gleason 8, T2 adenocarcinoma of the prostate.
| Immunohistochemical findings. CK7 positive tumor cells. |
What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
How Fast Does Prostate Cancer Spread To The Bones
Early detection can catch prostate cancer even before there are any symptoms. Some types of prostate cancer grow very slowly.
There are four main stages of prostate cancer. Within each stage, the cancer is graded based on factors like the size of tumor, prostate-specific antigen level, and other clinical signs.
If the cancer has spread to the bones, its considered to be the most advanced, or stage 4.
Newer lab tests look at the genes inside cancer cells. This can provide more information on how quickly the prostate cancer may progress.
Theres also a grading system known as the Gleason system, which assigns the cancer into a grade group based on how closely it resembles normal tissue.
During the biopsy to diagnose prostate cancer, the cells are closely examined. The more abnormal cells that are in the biopsy sample, the higher the Gleason score and grade group.
When more abnormal cells are present, the cancer is more likely to spread quickly.
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Can Prostate Cancer Spread To Lungs
Asked by: Ms. May Schultz I
Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. When it metastasizes, it usually spreads to bone and/or lymph nodes. A handful of cases have described prostatic metastases to the lung however, this is usually in the setting of existing bone lesions .
Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a diagnostic radiographer
- a therapeutic radiographer
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
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What Should You Ask Your Doctor About Treatments
The American Cancer Society recommends that you ask questions like these:
- What treatment might be best for me?
- What are the possible benefits of getting it?
- How soon would I need to start treatment?
- Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
- Will I need other treatments, too? If so, how might they benefit me?
- What side effects could my treatments cause? And what should I do if I get them?
- Is there a clinical trial that might be a good option for me?
- Can you review any vitamins or diet Iâm on to make sure it wonât interfere with my cancer treatment?
Pulmonary Metastasis As Sole Manifestation Of Relapse In Previously Treated Localised Prostate Cancer: Three Exceptional Case Reports
Joaquim Peres Gago1, Gabriela Câmara1, Jorge Dionísio2 and Ana Opinião1
1Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal
2Department of Pulmonology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal
Correspondence to: Joaquim Peres Gago. Email:
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What Is Advanced Prostate Cancer
Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when prostate cancer cells move through the blood stream or lymphatic system.
Watch our video about advanced prostate cancer.
You might hear cancer that has spread described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets. It is still prostate cancer, wherever it is in the body.
Prostate cancer can spread to any part of the body, but most commonly to the bones and lymph nodes. Lymph nodes are part of your lymphatic system, which is part of the bodys immune system. Lymph nodes are found throughout the body including in the pelvic area, near the prostate.
Advanced prostate cancer can cause symptoms, such as fatigue , bone pain, and problems urinating.
The symptoms you have will depend on where the cancer has spread to. Speak to your doctor or nurse if you have any symptoms. There are treatments available to help manage them.
Its not possible to cure advanced prostate cancer. But treatments can help keep it under control and manage any symptoms.
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How You Might Feel
When prostate cancer is advanced, it can no longer be cured. But treatment can control it for some time and help to relieve symptoms.
Finding out that your cancer cant be cured is distressing and can be a shock. Its common to feel uncertain and anxious. It’s normal not to be able to think about anything else.
Lots of information and support are available to you, your family and your friends. It can help to find out more about your cancer and the treatments you might have. Many people find that knowing more about their situation can make it easier to cope.
Talk to your doctor or nurse to understand:
- what your diagnosis means
What Is Metastatic Prostate Cancer
If your prostate cancer spreads to other parts of your body, your doctor may tell you that it’s “metastatic” or that your cancer has “metastasized.”
Most often, prostate cancer spreads to the bones or lymph nodes. It’s also common for it to spread to the liver or lungs. It’s rare for it to move to other organs, such as the brain, but that can happen.
It’s still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.
Metastatic prostate cancer is an advanced form of cancer. There’s no cure, but you take steps to treat and control it. Most men with advanced prostate cancer live a normal life for many years.
The goals of treatment are to:
- Manage symptoms
- Slow the rate your cancer grows
- Shrink the tumor
Some cancers are called “locally advanced.” That means the cancer has spread from the prostate to nearby tissue. It’s not the same as metastatic cancer since it hasn’t spread to other parts of your body. Many locally advanced prostate cancers can be cured.
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How Prostate Cancer Spreads
Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries â tiny blood vessels â at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most break-away cancer cells form new tumors. Many others donât survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.
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Prostatic Metastasis Of Pulmonary Large Cell Neuroendocrine Carcinoma
Kumi Shimizu1, Taichiro Goto2 , Arafumi Maeshima3, Yoshitaka Oyamada1, Ryoichi Kato2
1. Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan 2. Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan 3. Department of Pathology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Corresponding author: Taichiro Goto, MD., Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo 152-8902, Japan. Phone: +81-3-3411-0111 Fax: +81-3-3412-9811 Email: taichirojukuin.keio.ac.jp.More
Citation:J Cancer
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Symptoms Of Metastatic Prostate Cancer
Metastatic prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. It is also called advanced prostate cancer.
If your prostate cancer has spread you might:
- feel generally unwell
- have weight loss for no known reason
You might have specific symptoms depending on where the cancer has spread to. These symptoms can also be caused by other medical conditions so might not be a sign that the cancer has spread.
Neurologic Complications Of Prostate Cancer
RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California
Am Fam Physician. 2002 May 1 65:1834-1841.
This article exemplifies the AAFP 2002 Annual Clinical Focus on cancer: prevention, detection, management, support, and survival.
Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batsonâs plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.
More Common Neurologic Complications in Patients with Metastatic Prostate Cancer*
? = unknown.
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If Prostate Cancer Spreads
Cancer cells can spread from the prostate to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If prostate cancer spreads, it can spread to the:
- ejaculatory ducts
- seminal vesicles
- lymph nodes in the pelvis
- lymph nodes outside the pelvis
- American Joint Committee on Cancer. AJCC Cancer Staging Handbook. 7th ed. Chicago: Springer 2010.
- Brierley JD, Gospodarowicz MK, Wittekind C . TNM Classification of Malignant Tumours. 8th ed. Wiley Blackwell 2017.
- Hermanns T, Kuk C, Zlotta AR. Clinical presentation, diagnosis and staging. Nargund VH, Raghavan D, Sandler HM . Urological Oncology. Springer 2015: 40: 697-718.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
What Happens After Treatment
If you’ve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait several weeks after surgery before checking PSA levels.
A rise in PSA after treatment may suggest the cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.
Though very rare, it’s possible to have metastatic prostate cancer without a higher-than-normal PSA level.
Go to all of your follow-up doctor appointments. At these checkups, let your doctor know about any symptoms youâre having, especially ones like bone pain or blood in your pee. You could keep track of your symptoms by writing them down in a journal or diary.
At home, follow some healthy habits to feel your best:
Eat a balanced diet. It can boost your energy and your immune system. Fill your plate with fruits and vegetables and high-fiber foods. Cut back on fattening foods, sugar, and processed foods and meats.
Let your doctor know if youâre having trouble staying at a healthy weight or if youâre losing your appetite.
Get exercise if your doctor OKs it. It can be good for your body and mind. It can also help you stay at a healthy weight, keep up your strength, and help manage medication side effects.
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A Prostate Cancer Patient With Isolated Lung Metastases: A Case Report
Li-Xin Wu1#, Lei Lei2#, You-Cai Zhu1, Kai-Qi Du1, Xiao-Feng Li1, Hua-Fei Chen1, Wen-Xian Wang2, Chun-Wei Xu3
1 Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing 314000, Chinese Academy of Sciences University Cancer Hospital , Department of Respiratory Medicine, Jinling Hospital , Nanjing University School of Medicine , China
#These authors contributed equally to this work.
Correspondence to:
Abstract: Pulmonary involvement has been reported in > 40% of autopsy series in patients with metastatic prostate cancer however, isolated lung metastases have been documented in < 1% of cases and 43.5% cases underwent surgical resection and most of them have good outcome. We present a 74-year-old male Gleason high-grade prostate cancer patient with initially negative PSA and isolated pulmonary lesion which was confirmed as lung metastasis by resection. This patient received first-line endocrine therapy with leuprolide and bicalutamide endocrine and had a long-term disease-free follow-up of 3 years. The present patient had isolated lung metastasis with negative PSA, which was very rare in literature. Unexpected long-term disease-free survival was achieved after first-line endocrine therapy in this case with Gleason score of 8 metastatic prostate cancer. Whether or not the path of metastasis in this case was via lymph node jumping or hematogenous requires further investigation.
doi: 10.21037/tcr.2020.01.19
Cancers Likely To Metastasize
You may be surprised to learn that lung metastases are quite common. While almost any cancer can spread to the lungs, some are more likely than others to do so. With that, the most common types of cancer that metastasize to the lungs include:
Pulmonary metastases occur also very often in sarcoma, a relatively rare type of cancer. As many as 20% of soft tissue sarcomas and up to 40% of bone sarcomas develop lung metastases.
Occasionally, healthcare providers are unable to determine the primary site of cancer. In this case, they refer to the cancer as a cancer of unknown origin with metastasis to the lungs.
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