Prostate cancer with bladder neck involvement: Pathologic findings with application of a new practical method for tumor extent evaluation and recurrence-free survival after radical prostatectomy

Billis, Athanase; Freitas, Leandro Luiz Lopes de; Magna, Luís Alberto; Samara, Adil B; Ferreira, Ubirajara

doi:10.1007/s11255-004-0922-1

Cited by 25 publications

(27 citation statements)

References 20 publications

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“…Most of the previous studies [4][5][6][7]20 have found that bladder neck involvement carries a risk of progression similar to extraprostatic extension and lower than seminal vesicle invasion and suggested to consider downstaging bladder neck involvement in the TNM staging system. However, the lack of a consistent pathological definition of bladder neck involvement in different studies complicates the accurate determination of prognostic significance of microscopic bladder neck involvement.…”

Section: Discussionmentioning

confidence: 99%

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Microscopic bladder neck involvement by prostate carcinoma in radical prostatectomy specimens is not a significant independent prognostic factor

et al. 2009

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The independent prognostic importance of microscopic bladder neck involvement by prostate cancer in radical prostatectomy is questionable. We studied a cohort of 1845 patients to determine the significance of microscopic bladder neck involvement. Bladder neck involvement was defined as prostate cancer present within the coned bladder neck. We further categorized the cases as 'true bladder neck involvement' and 'false bladder neck involvement.' True bladder neck involvement required prostate cancer within thick smooth muscle bundles without intermixed benign prostatic glands. False bladder neck involvement was characterized by prostate cancer intermixed with benign prostatic glands. Bladder neck involvement was analyzed in relation to preoperative serum prostate-specific antigen (PSA) level, extraprostatic extension, seminal vesicle involvement, positive surgical margin, lymph node involvement, radical prostatectomy Gleason score, and tumor volume. Of the 90 patients (4.9%) with microscopic bladder neck involvement, 63 were further classified as true bladder neck involvement and 27 as false bladder neck involvement. In univariate model, both types of bladder neck involvement (Po0.001), true (Po0.001), and false (P ¼ 0.040), were significantly associated with increased PSA-recurrence risk compared to bladder neck negative cases. In multivariate model the PSA-recurrence relative risk associated with bladder neck involvement (true or false) was not a significant independent prognostic factor. Extraprostatic extension, seminal vesicle involvement, positive surgical margin, lymph node involvement, PSA, and Gleason score were significant independent predictors of PSA recurrence. The time to biochemical recurrence in patients with bladder neck involvement was similar to that of pT2 with positive surgical margin or pT3a with negative surgical margin patients (Kaplan-Meier curves). Bladder neck involvement was associated with other adverse pathologic features, but was not an independent predictor of PSA recurrence. In view of the previous and current data, the staging system for bladder neck involvement should be revised and patients may be best categorized as having pT3a disease.

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Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] The College of American Pathologists practice protocol on prostate specifically states that 'microscopic involvement of bladder neck muscle fibers in radical prostatectomy specimens should not be equated with a pT4 designation.' pT4 generally requires 'gross involvement of the bladder neck.'…”

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confidence: 99%

Microscopic bladder neck involvement by prostate carcinoma in radical prostatectomy specimens is not a significant independent prognostic factor

et al. 2009

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“…[53][54][55][56][57][58][59][60] Most studies 53,54,[58][59][60][61] have shown that bladder neck invasion carries a risk of progression similar to extraprostatic extension and lower than that of seminal vesicle invasion. This supports the concept that bladder neck invasion should be considered as pT3a disease, as these studies have shown that the prognosis of patients with bladder neck invasion is no worse than that for those with pT3 disease.…”

Section: Microscopic Bladder Neck Invasionmentioning

confidence: 99%

“…This supports the concept that bladder neck invasion should be considered as pT3a disease, as these studies have shown that the prognosis of patients with bladder neck invasion is no worse than that for those with pT3 disease. [53][54][55]57,[61][62][63] There is controversy as to whether microscopic bladder neck invasion remains an independent histological prognostic factor and predicts disease progression after radical prostatectomy. Some investigators have found that bladder neck invasion is associated with other well-established poor prognostic features such as higher Gleason score and serum PSA, extraprostatic extension, seminal vesicle invasion, positive surgical margins, positive lymph nodes and extensive tumor volume.…”

Section: Microscopic Bladder Neck Invasionmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease

et al. 2011

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made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a disease), bladder neck invasion, lymphovascular invasion and the definition of pT4 were coordinated by working group 3. It was agreed that prostate cancer can be categorized as pT3a in the absence of adipose tissue involvement when cancer bulges beyond the contour of the gland or beyond the condensed smooth muscle of the prostate at posterior and posterolateral sites. Extraprostatic extension can also be identified anteriorly. It was agreed that the location of extraprostatic extension should be reported. Although there was consensus that the amount of extraprostatic extension should be quantitated, there was no agreement as to which method of quantitation should be employed. There was overwhelming consensus that microscopic urinary bladder neck invasion by carcinoma should be reported as stage pT3a and that lymphovascular invasion by carcinoma should be reported. It is recommended that these elements are considered in the development of practice guidelines and in the daily practice of urological surgical pathology.

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“…of maximum tumor area using a single or multiple slide approach, 50 counting of the number of involved blocks, 51 assessment of the positive to negative block ratio, 52 use of an integration measuring grid, 27 point counting, 53,54 naked eye examination of the glass slides after all microscopically identifiable foci of carcinoma have been circled with a marking pen, 55 or, most simply, naked eye examination of sections without marking of tumor foci. 36 Authors of several landmark studies 34,35,37,50 have put forward that measurement of size or volume may be limited to assessment of the largest tumor nodule in a prostatectomy specimen and a method that may be appropriate is measurement of the maximum diameter of the largest tumor nodule in the transverse plane, after delineating the edges of the tumor on the glass slide.…”

Section: Measurement Of Tumor Volumementioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume

et al. 2011

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The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporting of tumor size/ volume and zonal location of prostate cancers were coordinated by working group 2. A survey circulated before the consensus conference demonstrated that 74% of the 157 participants considered pT2 substaging of prostate cancer to be of clinical and/or academic relevance. The survey also revealed a considerable variation in the frequency of reporting of pT2b substage prostate cancer, which was likely a consequence of the variable methodologies used to distinguish pT2a from pT2b tumors. Overview of the literature indicates that current pT2 substaging criteria lack clinical relevance and the majority (65.5%) of conference attendees wished to discontinue pT2 substaging. Therefore, the consensus was that reporting of pT2 substages should, at present, be optional. Several studies have shown that prostate cancer volume is significantly correlated with other clinicopathological features, including Gleason score and extraprostatic extension of tumor; however, most studies fail to demonstrate this to have prognostic significance on multivariate analysis. Consensus was reached with regard to the reporting of some quantitative measure of the volume of tumor in a prostatectomy specimen, without prescribing a specific methodology. Incorporation of the zonal and/or anterior location of the

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Prostate cancer with bladder neck involvement: Pathologic findings with application of a new practical method for tumor extent evaluation and recurrence-free survival after radical prostatectomy

Cited by 25 publications

References 20 publications

Microscopic bladder neck involvement by prostate carcinoma in radical prostatectomy specimens is not a significant independent prognostic factor

Microscopic bladder neck involvement by prostate carcinoma in radical prostatectomy specimens is not a significant independent prognostic factor

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume

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