A Review on Primary Angiosarcoma of the Prostate Gland: An Update | Chapter 05 | New Insights into Disease and Pathogen Research Vol. 4
Primary angiosarcoma of the prostate
(PASOP) is a very rare tumour which most clinicians have not encountered and
may be unaware of. Literature of PASOP was reviewed by obtaining information
from various internet data bases including: Google, Google Scholar, Educus and
PUB Med. Less than 20 cases of PASOP have been reported. PASOP may present in a
male child or adult with lower urinary tract symptoms, dysuria, haematuria,
pain and constipation. There may be in some cases a history of prior
radiotherapy for adenocarcinoma of prostate. Diagnosis is based upon
histological examination of prostate biopsy specimens which tend to reveal:
Proliferative vascular channels that are lined by atypical multi-layered or
atypical solid endothelial cells, variable pleomorphic tumour cells ranging
from spindle cells to large/plump cells; nuclei which are large and pleomorphic
and which contain clumped chromatin and prominent nucleoli; mitotic figures of
which some may look atypical are frequently seen. PASOPs on immunohistochemical
staining tend to stain positively for CD34, Factor 8 (Factor VIII), Vimentin.
PASOPs on immunohistochemical staining tend to exhibit negative staining for
PSA, Keratin and S-100. Surgical resection with surgical margins that are clear
of tumor has been shown to be the treatment associated with a chance of long-term
survival but a number of reported cases of PASOP at the time of initial
diagnosis had presented with metastatic disease or locally advanced disease and
curative surgery with clear surgical margins has been impossible. Various
adjuvant therapies had been reported but on the whole the prognosis has been
poor. There is on the whole no consensus opinion on the best management options
for all stages of the disease. PASOP is a rare aggressive disease. Clinicians
should report cases of PASOP they encounter and should enter them into a
multi-centre trial to find the best treatment option. Perhaps if patients who
develop relapse disease who had previously undergone radiotherapy for prostate
cancer undergo further biopsies of prostate may be new cases of PASOP would be
diagnosed in the new biopsy specimens and this could illustrate that PASOPS are
not as uncommon as used to be believed.
Author(s) Details
Anthony Kodzo-Grey Venyo
[MB ChB FRCS(Ed) FRCSI FGCS Urol. LLM]
Department of Urology, North
Manchester General Hospital, Delaunay’s Road, Manchester, United Kingdom.
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