Diagnosis and Management of Primary Prostatic Signet Ring Cell Carcinoma: Single Center Experience

Background: Primary prostatic signet ring cell carcinoma (PPSRCC) is an extremely rare malignant tumor without definitive treatment approach. Herein, we retrospectively summarized the experience of diagnosis and management of ten PPSRCC cases. Methods: A total of ten PPSRCC patients were included in this study definitely diagnosed by postoperative pathology at the First Affiliated Hospital of Nanjing Medical University from November 2001 to December 2020. Clinical characteristics, image features, therapeutic procedures, histological diagnosis and outcomes of them were retrospectively analyzed. Results: Characteristics of the patient population were ten males with age of 67.8±7.2 years. Among them, five cases were asymptomatic and five were manifested as dysuria. All ten patients received PSA examination preoperatively. Nine patients of ten accepted multiparametric MRI due to elevated PSA value, and further adopted prostatic biopsy. Among them, five patients were diagnosed as prostatic adenocarcinoma, and the other four cases were found a mixture of SRCC and adenocarcinoma. The above nine patients accepted laparoscopic or robot-assisted radical prostatectomy. Only one patient with normal PSA value adopted TURP. Postoperatively pathological results confirmed SRCC mixed with prostatic adenocarcinoma in nine cases, and only one patient with pure SRCC. After surgery, nine patients received adjuvant hormone therapy, one of which accepted radiotherapy simultaneously. The other one patient with pure SRCC didn’t accept any adjuvant therapy. None of the ten cases had gastrointestinal tumor history. During a mean follow-up of 43.6 months, eight patients were alive without obvious disease progression. Conclusions : In summary, PPSRCC is a rare malignant tumor with few early symptoms, highly malignancy, rapid disease progression and poor prognosis. PPSRCC is frequently accompanied by high grade prostate adenocarcinoma patterns. Early diagnosis and timely radical resection of prostate cancer, endocrine therapy, radiotherapy and chemotherapy may improve the prognosis.