Prostate sarcoma

　　Prostate sarcoma originates from the mesoderm of the reproductive tract, including the terminal parts of the Wolffian duct and Müllerian duct, and can also come from the circular muscle layer of the urogenital sinus. The etiology may be related to embryonic development, developmental malformations, prostatitis, and perineal trauma, but the main trigger factor has not been elucidated so far.

　　The phenomenon of malignant tumors induced by radiation has been described in detail after Frieben reported it in 1902 and Perthes in 1904. In 1922, Beck first described sarcomas induced by radiotherapy. Literature reports that sarcomas induced by radiotherapy mainly occur in bones, chest wall, uterus, breast, retroperitoneum, liver, mediastinum, pelvis, blood, muscles, thyroid, parathyroid tissue, lung, and stomach. Michael Scully reported a case of prostate cancer that developed into sarcoma eight years after transurethral resection of the prostate (TURP) and implantation of 125 iodine (125Ⅰ) for radiotherapy. There are also reports of two patients with locally radiotherapy for prostate cancer who showed sarcomatous changes. Radiotherapy may be a potential cause of prostate sarcoma.

　　A biopsy is required during the pathological examination of prostatic sarcoma, and repeated multiple biopsies can improve the accuracy of diagnosis, but it may cause complications such as bleeding, infection, and tumor spread.

　　There are no symptoms in the early stage of this disease, and when symptoms appear, the tumor is quite large. General early symptoms are obstruction at the neck of the bladder, and the tumor compressing the bladder base or invading the urethra can affect urination, showing symptoms such as frequent urination, dysuria, and difficulty in urination. Gross hematuria is rare, and in severe cases, it can compress the rectum, causing difficulty in defecation. Late symptoms include pain, weight loss, anemia, and cachexia, which are easy to metastasize to the lung, liver, and bone.

　　The etiology of this disease is not yet clear. Understanding the risk factors of the tumor and formulating corresponding prevention and treatment strategies can reduce the risk of the tumor. Currently, the focus of tumor prevention and treatment should be to first pay attention to and improve those factors closely related to life, such as smoking cessation, reasonable diet, regular exercise, and weight reduction. Anyone who follows these simple and reasonable common sense of lifestyle can reduce the chance of getting cancer.

　　The main clinical examination methods for prostatic sarcoma are as follows:

　　1. Ultrasound examination.The examination shows an enlarged prostate volume protruding into the bladder, with irregular or defective echo of the capsule and a solid hyperechoic area inside.

　　2. CT examination.The examination shows isolated hypodense areas caused by tumor necrosis, as well as signs of involvement of the bladder, rectum, and pelvic muscles.

　　3. Cystoscopy.The bladder capacity decreases due to inward compression by the mass, and the bladder neck and trigone compress the bladder from outside to inside, forming an external pressure mass.

　　4. Cysto-urethrogram examination.The examination shows compression, deformation, and displacement of the bladder and urethra, with a large filling defect shadow protruding into the bladder at the neck of the bladder.

　　5. IVU examination.Most patients have no obvious abnormalities in IVU, but if the lower end of the bilateral ureters is compressed by the tumor, it moves upwards, and IVU shows dilatation and effusion of the bilateral ureters and renal pelvis, with the ureters reversing upwards in a hook-like shape.

　　6. X-ray examination.When there is metastasis of the tumor, X-ray pelvis radiography shows bone destruction lesions. The bone metastasis of prostatic sarcoma is different from that of prostate cancer, as the sarcoma bone metastasis is more extensive and is osteolytic destruction, whereas the bone metastasis of prostate cancer is often osteogenic.

　　7. Radioisotope examination.Recent literature reports that the use of 131I-labeled monoclonal antibody Rud10 in immunoscintigraphy plays an important role in the diagnosis of rhabdomyosarcoma. This method is an important supplement to existing diagnostic methods, and radioactive bone scans can show bone destruction when there is bone metastasis of the tumor.

　　8. MRI examination.Magnetic resonance imaging (MRI) is widely used in tumor staging due to its good contrast and spatial resolution. MRI scans in the sagittal and coronal planes give it a significant advantage in diagnosing tumors at the neck and apex of the bladder. If the tumor invades the prostate and seminal vesicle, MRI has good application value.

　　9. Prostate Biopsy.Prostate biopsy is an extremely important examination method. Pathology can be obtained from it to clarify the diagnosis and determine the pathological tissue type, which is of great significance for guiding the radiotherapy and chemotherapy of advanced patients who cannot undergo surgery.

　　Phytoestrogens in legumes can reduce the tumor risk of androgens. Many foods in nature contain phytoestrogens, such as soybeans, peanuts, and so on, which can be eaten appropriately more. Eat less high-calorie foods. Try to eat less high-fat foods, such as beef, pork, and other meats and vegetable oils.

　　The course of prostate sarcoma develops very quickly. In traditional Chinese medicine, the syndrome differentiation and typing of prostate sarcoma is divided into syndrome and deficiency syndrome. Treatment is carried out according to the different symptoms of each type, which has a certain therapeutic effect on the course of prostate sarcoma.

　　1. Prostate Sarcoma Syndrome

　　Main SymptomsSymptoms: Frequent urination, urgency, dysuria, small amount of urine or no urine, or hematuria, perineal pain, later accompanied by lower limb pain, cough, hemoptysis.

　　Therapeutic PrincipleTo clear heat and promote diuresis, dissolve blood stasis and soften hardness.

　　PrescriptionCassia, Gardenia, Persica, Plantago asiatica, Bubalus bubalis, Angelica sinensis, Solanum nigrum, Prunus serotina, Rehmannia, Solanum lyratum, Momordica, Natrium sulfat, Curcuma, Apis mellifera.

　　Method of ConsumptionDecocted in water, taken in two doses, one dose per day.

　　2. Prostate Sarcoma Deficiency Syndrome

　　Main SymptomsSymptoms: Distension and坠胀 in the lower abdomen, frequent desire to urinate but unable to, or urination is small and not smooth, or blocked and not flowing, occasionally hematuria, pale complexion, cold and sore knees, weak and tired, pale tongue with white, moist fur, deep and thin pulse.

　　Therapeutic PrincipleTo invigorate the spleen and kidney, and remove toxins and promote diuresis.

　　PrescriptionFor those with deficient middle Qi: Ginseng, Alisma, Atractylodes, Poria, Solanum lyratum, Solanum nigrum, Momordica, Poria, Cinnamomum cassia, Astragalus, Citrus peel. For those with deficient kidney Qi: Prunus, Rehmannia, Dioscorea, Plantago asiatica, Solanum lyratum, Solanum nigrum, Momordica, Agkistrodon acutus, Moutan bark, Poria, Alisma, Cinnamon twigs.

　　Method of ConsumptionDecocted in water, taken in two doses, one dose per day.