Prostatic involvement by urothelial carcinoma of the bladder: clinicopathological features and outcome after radical cystectomy (original) (raw)
Related papers
Urothelial Carcinoma of the Prostate
Urology, 2007
This study was conducted to explore the diagnosis and management of urothelial carcinoma of the prostate in superficial disease and carcinoma in situ, stromal invasion, primary urothelial carcinoma, and urethral recurrence after radical surgery. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) reviewed the diagnosis and management of urothelial carcinoma of the bladder. English-language literature about urothelial carcinoma of the prostate was identified and reviewed. Evidence-based recommendations for the diagnosis and management of urothelial carcinoma were made. Many recommendations were level 3 or 4 citations involving the diagnosis and management of superficial urothelial carcinoma; a few were level 2 citations. Level 1 citations related only to chemotherapy and radiotherapy in patients with stromal invasion, although these were not related specifically to invasive prostatic involvement. More than 130 reviewed citations are summarized in this review. Published reports on the diagnosis and treatment of superficial urothelial disease of the prostate primarily consist of short case series from individual centers. Prospective and multicenter trials are needed to identify the real incidence and the best management of these patients. In invasive disease of the prostate, the only large series were designed to investigate invasive bladder cancer. UROLOGY 69 (Suppl 1A): 50 -61, 2007. © 2007 Cystectomy Specimens. Most reports of prostatic urethral involvement at the time of radical cystectomy are retrospective and lack careful pathologic assessment of the prostate; thus, it is likely that the true incidence of involvement with urothelial carcinoma is underreported. However, the incidence of prostatic urethral involvement approaches 50% in series in which detailed pathologic assessment of the prostate is performed. Wood et al. reported a 43% incidence of urothelial carcinoma of the prostate in cystectomy specimens (level 3). In this series, 94% of those with prostatic involvement exhibited disease in the prostatic urethra, including 67% with CIS of the prostatic ducts or acini. Risk factors included CIS of the bladder neck or trigone, prior intravesical therapy,
Prostate-sparing Cystectomy for Bladder Cancer: A Step Toward a Dead-end
Urology, 2010
B ladder tumors account for 90%-95% of urothelial carcinomas. 1 Bladder cancer is ranked as the 11th most common cancer in the world and more than 50% of cases occur in developed countries. 1 Open radical cystoprostatectomy (RCP) remains the gold standard procedure for the management of men with invasive bladder cancer. This surgery affords the best possible oncological control, despite severe functional side effects (ie, male sexuality, continence, and general quality of daily life) caused by the removal of the bladder, prostate, and seminal vesicles. Thus, selective surgical techniques for RCP and ileal orthotopic neobladder have been proposed. The aim of preserving neurovascular bundles and/or the urethral sphincter is to improve the functional outcome, notably in younger patients. 4 However, nearly half of the patients still underwent functional complications, particularly the loss of potency. 4 Therefore, prostate-sparing cystectomy (PSC) was proposed to further improve functional outcomes. The rationale for PSC is to spare the prostate and the seminal vesicles to maintain reproductive ability in younger patients. 5 In addition, PSC aims to improve functional outcomes so that surgery will be me more easily accepted by patients. However, this goal must not compromise the oncological issue. Invasive urothelial carcinomas behave aggressively, and it has been feared that PSC might be associated with a higher risk of recurrence, although this remains a matter of controversy. 6-8 It had been postulated that the preservation of the prostate might facilitate tumor dissemination and result in a higher rate of recurrence, leading several groups to suggest that PSC should be avoided whenever the bladder tumor invades the muscle wall. 6 Our aim was to assess the oncological and functional results after PSC for invasive bladder carcinomas.
The Journal of Urology, 2013
Purpose: We identified risk factors and determined the incidence and prognosis of incidental, clinically significant prostatic adenocarcinoma, prostatic urothelial carcinoma and HGPIN in patients treated with radical cystoprostatectomy for urothelial carcinoma of the bladder. Materials and Methods: We analyzed the records of 1,476 patients without a history of prostatic adenocarcinoma. We determined the incidence of clinically significant prostatic adenocarcinoma, prostatic urothelial carcinoma and HGPIN in the total cohort and in select patient subgroups. Prostatic urothelial carcinoma was stratified as prostatic stromal and prostatic urethral/duct involvement. Univariate and multivariate analyses were performed with multiple variables. Recurrence-free and overall survival rates were calculated. Median followup was 13.2 years. Results: Of the 1,476 patients 753 (51.0%) had cancer involving the prostate. Prostatic adenocarcinoma, clinically significant prostatic adenocarcinoma, prostatic urothelial carcinoma and HGPIN were present in 37.9%, 8.3%, 21.1% and 51.2% of patients, respectively. Of the 312 patients (21.1%) with prostatic urothelial carcinoma 163 (11.0%) had prostatic urethral/duct involvement only and 149 (10.1%) had prostatic stromal involvement. We identified risk factors for clinically significant prostatic adenocarcinoma, prostatic urothelial carcinoma and HGPIN but the absence of these risk factors did not rule out their presence.
Predictive factors for prostatic involvement by transitional cell carcinoma of the bladder
Urology journal, 2011
To evaluate the predictive factors for prostatic involvement according to the bladder transitional cell carcinoma (TCC) characteristics in a prospective study. Hundred patients with the bladder TCC who had undergone standard radical cystoprostatectomy were enrolled in this study. A number of factors, including vascular and perineural invasion, number of tumors, maximum diameter of the tumor, presence of carcinoma in situ, distance between the tumor and the bladder neck, grade, and local stage of the tumor were recorded, and their relationships with prostatic involvement were studied. In addition, hydronephrosis and age of the patients were included in the analysis. The mean age of the patients was 62.6 ± 10.8 years. Of a total of 100 patients, 21 (75%) were found to have prostatic involvement with TCC. Univariate statistical analysis showed that vascular invasion and the distance between the tumor and the bladder neck were significantly related to the prostatic involvement (P = .001...
International braz j urol, 2004
Objective: To assess the incidence of bladder carcinoma infiltrating the prostate and prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer, as well as to assess if the characteristics of the bladder neoplasia influence the prostatic involvement by this neoplasia. Materials and Methods: We retrospectively assessed 60 male patients, who underwent radical cystoprostatectomy between July 1997 and December 2003. Mean age was 66.7 years (40 and 93 years). The product of radical cystoprostatectomies was checked for involvement of urethra and prostate parenchyma by the primary neoplasia, and for the presence of associated prostate adenocarcinoma. Bladder neoplasia characteristics, such as localization, size, multifocality, association with in situ carcinoma and histological grade, were studied in order to assess the possibility of using such characteristics as predictive factors of prostate infiltration by bladder urothelial carcinoma. Results: We observed the presence of 20% of patients with bladder carcinoma infiltrating the prostatic urethra, 23.3% of patients with infiltration of the prostate parenchyma and 28.3% of patients with associate prostate adenocarcinoma, resulting in a total of 55% of patients with prostatic involvement (infiltrative bladder carcinoma and/or adenocarcinoma). We also observed a statistically significant correlation between tumor location in the trigone, the presence of in situ carcinoma and the histological grade of the bladder tumor with prostatic infiltration by the vesical neoplasia. Conclusion: The coexistence of prostatic neoplasia in patients operated for bladder neoplasia was frequent in our sample (55%). We observed that the prostatic infiltration by bladder tumors occurs more frequently with tumors located in the trigone, with associated in situ carcinoma and with high histological grade. There was no correlation between neoplastic infiltration of prostate and multifocality or size of the bladder tumor in the studied sample.
International Journal of Clinical Oncology, 2013
Background This study retrospectively evaluated the clinical relevance of transurethral prostate biopsy (TUPB) before radical cystectomy by comparing the pathology of prostatic urethra biopsy specimens with that of cystectomy specimens. Methods Of 294 patients who underwent cystectomy and urinary diversion, 101 men with preoperative TUPB were included in this study. For these patients, if the result of TUPB was positive for urothelial carcinoma, we performed urethrectomy as a rule. If it was negative, we presented the option of urethral preservation and decided the final type of urinary reconstruction. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of TUPB were assessed, and we investigated the number of final urethral recurrences. We also tried to identify which clinical and pathological findings by TUPB most accurately predicted the disease remaining in the prostate of cystectomy specimens. Results Of the 25 patients with positive TUPB, 18 had disease in the prostatic urethra or stroma of cystectomy specimens. There were 3 patients with negative TUPB but with involvement of the prostate in cystectomy specimens. Thus, TUPB achieved 86% sensitivity, 91% specificity, 72% PPV, and 96% NPV. Two patients (1.9%) had urethral recurrence in this period. Among the findings for TUPB, non-papillary tumors most accurately predicted the disease in the prostate of cystectomy specimens. Conclusions TUPB achieved a high NPV and the urethral recurrence rate was acceptable. If TUPB was negative, patients could have chance urethral preservation. Thus, our clinical decision for urethrectomy based on the result of TUPB is still useful.
RADICAL PROSTATECTOMY IN VERY HIGH RISK LOCALIZED PROSTATE CANCER
The Journal of Urology, 2009
Objective. The objective of this study was to present the long-term outcomes and determine outcome predictors in very highrisk (cT3b-T4) prostate cancer (PCa) after radical prostatectomy (RP). Material and methods. Between January 1989 and December 2004, 51 patients with cT3b-T4 PCa underwent RP. Kaplan-Meier survival analysis was used to calculate the biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS), cancer-specific survival (CSS) and overall survival (OS) rate. Multivariate Cox proportional hazard models were used to determine the predictive power of clinical and pathological variables in BPFS and CPFS. Results. Median follow-up was 108 months [interquartile range (IQR) 73.5-144.5]. The median serum prostate-specific antigen (PSA) was 16.9 ng/ml (IQR 7-37.2). Median biopsy and pathological Gleason (pGS) score were both scored as 7 (range 4-10 and 5-9, respectively). Overstaging was frequent (37.2%); four patients (7.8%) had organ-confined stage pT2, while 15 (29.4%) had extracapsular extension only (pT3a). Another 23 (45.1%) were confirmed with seminal vesicle invasion (pT3b) and nine (17.7%) had adjacent structure invasion (pT4). Eleven patients (21.6%) had lymph-node involvement. Thirty-two patients (62.7%) had positive surgical margins. The BPFS, CPFS, CSS and OS at 5 and 10 years were 52.7%, 45.8%;78.0%, 72.5%; 91.9%, 91.9% and 88.0%, 70.7%. In the multivariate Cox proportional hazard models, pathological stage was an independent predictor of BPFS while preoperative PSA and pGS was an independent predictor of CPFS. Conclusions. The management of cT3b-T4 PCa typically consists of a multimodality treatment in which RP is a valuable first step. Overstaging was frequent (37.2%), and almost one-quarter of the patients remained free of additional treatments. Long-term cancer-related outcomes were very satisfactory. Scand J Urol Nephrol Downloaded from informahealthcare.com by K U Leuven on 02/06/15 For personal use only. PSA (ng/ml), median (range) 16.9 (2.8-123) Clinical stage cT3b, n (%) 41 (80.4) cT4, n (%) 10 (19.6) Biopsy Gleason score, median (range) 7 (4-10) Specimen Gleason score, median (range) 7 (5-9) Pathological stage, n (%) pT2 4 (7.8) pT3a 15 (29.4) pT3b 23 (45.1) pT4 9 (17.7) Positive lymph node, n (%) 11 (21.6) Positive surgical margin, n (%) 32 (62.7) Neoadjuvant ADT, n (%) 17 (33.3) Adjuvant RT and/or ADT, n (%) 27 (52.9) Salvage treatment, n (%) 18 (35.3) PSA = prostate-specific antigen; ADT = androgen deprivation therapy; RT = radiotherapy. 166 S. Joniau et al. Scand J Urol Nephrol Downloaded from informahealthcare.com by K U Leuven on 02/06/15
BJU International, 2008
To investigate possible associated pathology in the prostate removed from patients with invasive bladder cancer and determine if there is a justification for prostate-sparing cystectomy. Between March 2005 and July 2007, 425 men (mean age 59 years, sd 8.23) had a cystoprostatectomy at our institute. The prostate was step sectioned at 2-3 mm intervals and any associated pathology determined; patient and tumour characteristics were correlated with prostatic pathology. The results were compared with those published previously, and the potential functional advantages of prostate sparing are reviewed and discussed. Prostatic adenocarcinoma was detected in 90 of the 425 (21.2%) patients. There was no significant correlation between preoperative prostate-specific antigen level and the presence of adenocarcinoma, Gleason score or prostatic tumour stage. There was prostatic involvement as a result of direct invasion by the primary bladder tumour (contiguous) in 39 cases (9.2%). Concomitant (non-contiguous) transitional cell carcinoma of the prostatic urethra and/or ducts was detected in 27 specimens (6.4%). Additional findings were high-grade prostatic intraepithelial neoplasia in 43 patients (10.1%) and benign prostatic hyperplasia in 175 (41.2%). We think that the potential oncological risks of prostate-sparing cystectomy outweigh any small and possible functional benefits; accordingly, the prostate should not be retained.