Prostatic stromal tumors with uncertain malignant potential: A scoping review of clinical challenges and management strategies

Abstract Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare neoplasm arising from specialized prostatic stromal cells with a broad range of histologic patterns and unpredictable clinical behavior. It is often challenging to distinguish STUMP from prostatic stromal sarcoma due to morphological similarities, necessitating specific microscopic criteria and immunohistochemical analysis. Owing to its rarity and variable presentation, there is no clear consensus on its classification, clinical course, or management. This review aims to analyze the demographic, clinical, and pathological features of STUMP, along with available treatment strategies and outcomes. This comprehensive literature review was conducted using PubMed and Google Scholar databases, focusing on cases of pure STUMP. Selected studies were assessed for clinical presentations, pathological findings, diagnostic procedures, and treatments. This scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA‐ScR checklist. Case reports were further assessed using the Murad et al. quality assessment tool. An analysis of 84 patients across 14 studies revealed a mean age at diagnosis of 58.9 years. Common clinical presentations included lower urinary tract symptoms (39.3%) and urinary retention (29.8%). Immunohistochemical markers such as vimentin, estrogen receptor, smooth muscle actin (SMA), and progesterone receptor were frequently expressed. Initial management strategies varied: 34.5% of patients were managed with observation, while others underwent interventions such as transurethral resection of prostate (TURP) or prostatectomy. During follow‐up, 19 patients (22%) experienced disease progression, with a higher recurrence rate observed in non‐prostatectomy groups (34.5%). In contrast, no recurrence was noted among those who underwent prostatectomy or enucleation. Among the patients with progression, 89.5% required further intervention, most commonly repeat TURP or prostatectomy. In conclusion, Prostatic STUMP is a rare tumor with diverse histologic patterns and clinical behaviors. Given its potential for progression and risk of sarcomatous transformation, complete surgical excision is the recommended management strategy.