BMJ Case Reports 2018; doi:10.1136/bcr-2018-225295
  • Rare disease

Secondary spindle cell sarcoma following external beam radiotherapy for prostate cancer: a rare but devastating complication

  1. Lih-Ming Wong1
  1. 1Department of Urology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
  2. 2Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr Matthew Farag, mattyfarag{at}
  • Accepted 22 June 2018
  • Published 11 July 2018


We report a case of rapidly growing sarcoma that resulted in mortality only 6 years after radiotherapy for low-grade prostate cancer.

At the age of 69 years and a prostate-specific antigen (PSA) that had risen to 9.0 µg/L, transrectal ultrasound-guided biopsy of the prostate found a single core of Gleason 3+3 disease involving 4 mm of a 10 mm core. The patient declined active surveillance and completed 78 Gy of external beam radiotherapy over 39 fractions to a prostate volume of 46 mL.

His PSA nadir was 0.62 µg/L 1-year postradiation; however, in April 2017, his PSA began to rise satisfying the definition of biochemical recurrence. He underwent cystoscopy, biopsy favoured an undifferentiated pleomorphic sarcoma. Restaging scans (CT/bone scan) were completed showing no metastasis, and repeat MRI showed rapid growth of the lesion in 3 months.

He underwent palliative pelvic exenteration, however, 1 month later presented with large volume tumour recurrence and was subsequently palliated and died.


  • Contributors Dr Matthew Farag is the surgical resident present on the case and main author collating data and writing up report. Mr Lih-Ming Wong is the head of the urological surgical team. Dr Anthony Ta is the urological surgical registrar involved with this case. Dr Siva Shankar is the radio-oncologist administering radiotherapy for this case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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