Article Text

Secondary spindle cell sarcoma following external beam radiotherapy for prostate cancer: a rare but devastating complication
  1. Matthew Farag1,
  2. Anthony Ta1,
  3. Siva Shankar2,
  4. 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}


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.

  • prostate
  • urological surgery
  • prostate cancer
  • radiotherapy
  • urological cancer

Statistics from


  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.