title: Multimodal Therapy in the Treatment of Prostate Sarcoma: The Johns Hopkins Experience.
abstract: BACKGROUND
  The objective of this study was to evaluate the use of neoadjuvant chemoradiation in patients with prostate sarcoma treated at our institution and report oncological outcomes.
  
  
  METHODS
  The records of patients with intermediate- or high-grade prostate sarcoma treated with curative intent at our institution from 1993 to 2013 were reviewed. Patient demographic information, tumor characteristics, and treatment modalities used were assessed. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were calculated.
  
  
  RESULTS
  Eight patients met inclusion criteria. The mean age at presentation was 64 years, and urinary obstruction was the most common presenting symptom. All patients underwent surgical resection and neoadjuvant radiation and 6 had concurrent chemotherapy. Four patients received intraoperative radiation. With a median follow-up of 36 months, there were no local recurrences, 6 metastases, 4 deaths from disease, and no deaths from other causes. The median OS and CSS was 67.8 months, with actuarial OS and CSS rates of 100% at 1 year, 75% at 2 years, 62.5% at 3 years, and 62.5% at 5 years. Median RFS was 14.2 months, with actuarial RFS rate of 75% at 1 year, 37.5% at 2 years, and 25% at 3 years.
  
  
  CONCLUSIONS
  Prostate sarcomas are rarely cured using surgical resection alone. Our cohort treated with a multimodality approach had favorable CSS and RFS compared with historic and contemporary series of surgery alone and no local recurrences. Most patients developed metastatic recurrence, highlighting the aggressive nature of this disease.
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: mark.ball@jhmi.edu.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Debasish
authors.initials: D
authors.lastname: Sundi
authors.affiliation: Department of Urology, Temple University School of Medicine, Philadephia, PA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reese
authors.affiliation: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Meyer
authors.affiliation: Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Efron
authors.affiliation: Department of Urology, The Albert Einstein College of Medicine and The Montefiore Medical Center, Bronx, NY.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis
keywords: Leiomyosarcoma; Mesenchymal tumor; Neoadjuvant chemotherapy; Radiation; Surgery