Concomitant bladder cancer and prostate cancer: challenges and controversies

Abstract

Radical cystoprostatectomy (RCP) followed by bilateral pelvic lymphadenectomy and urinary diversion remains the gold-standard therapy for men with localized muscle-invasive bladder cancer (MIBC). Prostate cancer might be incidentally detected at the time of RCP with a reported prevalence of 24-51%. Typically, these patients are considered to have clinically insignificant disease, but data from emerging series challenge this assumption and suggest that some of these tumours might be aggressive, or somehow increase the aggressiveness of the associated MIBC, and can negatively influence the patient's overall survival outcomes. Furthermore, the potential use of prostate-sparing cystectomy in patients with less-aggressive MIBC might lead to newly diagnosed incidental cases of prostate cancer, with characteristics suggestive of clinically significant disease, requiring a specific, separate workup. The development of evidence-based, validated protocols to define the necessary steps for diagnosis of prostate cancer in these patients, including the role of serum PSA testing, digital rectal examination, the role of imaging methods and the indication and type of biopsy protocol, is of major importance to the multidisciplinary management of patients with urological cancer. Finally, the retrospective nature of the available data account for much of the variability in the prevalence of coexisting bladder and prostate cancer and emphasizes the need for randomized trials in this controversial area of urological oncology.

Hypoxia-elevated circELP3 contributes to bladder cancer progression and cisplatin resistance

“…Hence, to some degree, we can say that cisplatin resistance shortens the survival of advanced bladder cancer patients. To address this drawback, cisplatin-based combined therapies are increasingly used in clinical bladder cancer treatment, such as cisplatin chemotherapy combined with a PD-L1 inhibitor 24. Although some cases have shown improved clinical outcomes, drug resistance is still considered the major obstacle, and we only partially attribute this alleviation to immunity-related issues due to the PD-L1 inhibitor.…”

Urothelial carcinoma with mandibular metastasis and synchronous prostate cancer

“…We present a case of non-muscle invasive urothelial cancer metastasised to the mandible and synchronous high-risk prostate cancer (PC). Incidental finding of PC in BC patients is generally clinically insignificant; however, there is some data to suggest that synchronous high-risk PC has poor survival prognosis for non-metastatic BC and treating PC improves the progression-free survival for BC 6 7. Our case highlights the importance of considering mandibular metastasis early in the differential when a patient presents with mental nerve neuropathy as well as treating synchronous PC that may affect overall survival.…”

“…Our patient was found to have non-muscle invasive urothelial cancer that metastasised to the mandible as well as high-risk PC. PC is detected in 24%–51% of patients undergoing radical cystoprostatectomy for muscle invasive BC and up to 29% of these being high-risk PC 6. Incidentally diagnosed PC with Gleason score <6 does not affect overall survival of BC patients, but in a case series of 945 men with BC having radical cystoprostatectomy, Thomas et al found that synchronous high-risk PC with Gleason score of ≥7 and age >60 carried a poor survival prognosis for non-metastatic BC 7.…”

“…Incidentally diagnosed PC with Gleason score <6 does not affect overall survival of BC patients, but in a case series of 945 men with BC having radical cystoprostatectomy, Thomas et al found that synchronous high-risk PC with Gleason score of ≥7 and age >60 carried a poor survival prognosis for non-metastatic BC 7. The high concurrence of prostate and BC has led to theories of common carcinogenic pathway through mutations in tumour suppressor genes and effect of androgen receptor signalling involved in development and progression of both cancers 6…”

Mutant GT198 in angiogenesis as a common origin of human prostate and bladder cancers

“…Prostate cancer and bladder cancer are prevalent cancers in men. Clinical evidence has previously suggested that prostate and bladder cancers have higher concomitant incidence with a potential common pathway in tumor development (1)(2)(3).…”