Robot-assisted laparoscopic radical prostatectomy for leiomyosarcoma of the prostate: A case report

Prostate leiomyosarcomas are rare malignancies. We report the case of a 53-year-old man with locally confined prostate leiomyosarcoma treated with robot-assisted laparoscopic radical prostatectomy (RARP). The patient reported frequent urination, and imaging demonstrated a well-circumscribed tumor compressing the bladder wall. Histopathological examination confirmed the diagnosis of leiomyosarcoma, with immunohistochemical positivity for α-smooth muscle actin, desmin, and h-caldesmon. Preoperative staging revealed no distant metastases, and RARP was subsequently performed. A vertical incision was made in the anterior bladder wall, facilitating the identification of the tumor arising from the ventral aspect of the prostate. Anterior bladder neck transection was achieved through intravesical resection, maintaining a safety margin of the bladder wall from the tumor. Postoperative recovery was uneventful, and the patient remained disease free and fully continent 12 months after surgery. No gold standard treatment has been established for leiomyosarcoma of the prostate; however, complete surgical resection with clear margins remains the mainstay of treatment. In cases with well-defined tumor margins, RARP with an adequate safety margin may be a viable option while preserving the postoperative quality of life and avoiding the need for a stoma. This case report suggests that RARP can be safely and effectively applied in the management of noninvasive prostate leiomyosarcoma.