Prostate Biopsy in Young Patients with Hematospermia Without an Indication for Biopsy Contributed to the Early Diagnosis of Prostate Sarcoma: A Case Report

Background: Prostate sarcoma is a rare group of prostate primary malignant tumors with a poor prognosis, and its early diagnosis is challenging. Here we report a case of early diagnosis of prostate sarcoma and summarize the clinical characteristics of this group of patients. Case presentation: We present a case of a 40-year-old male patient with prostate leiomyosarcoma having hematospermia as the initial symptom. His prostate-specific antigen was 2.97 ng/ml, magnetic resonance imaging showed a prostate nodule with possible bleeding at the lesion margins with Prostate Imaging Reporting and Data System (PI-RADS) category 2. According to the guidelines, prostate biopsy was not recommended, but we learned from our previous experience and still recommended him for prostate biopsy. With his consent, a combined prostate biopsy was performed, and he received an early diagnosis of prostate leiomyosarcoma 19 days after the initial symptom of hematospermia. Reviewing previous cases of prostate sarcoma patients at our medical center, we found that the best time for diagnosis and treatment were generally missed. Conclusions: : Combination with magnetic resonance imaging is contributive to the early diagnoses of prostate sarcoma. Therefore, when young patients present with repeated hematospermia, even if they have normal prostate-specific antigen, it is important to be alert to the possibility of prostate sarcoma, and multiparametric magnetic resonance imaging rather than ultrasound is recommended, and if MRI reveals prostate lesions, it is recommended to be biopsied regardless of PI-RADS categories, and a combined biopsy is recommended.