Prostatic involvement by urothelial carcinoma of the bladder: clinicopathological features and outcome after radical cystectomy

Abstract

OBJECTIVES To review the long‐term outcome of prostatic involvement in patients with bladder cancer (BC) treated with radical cystectomy (RC), as urothelial carcinoma (UC) involving the prostate occurs in such patients, and prostatic invasion by UC is by transmural invasion (contiguous), or when UC develops from the epithelium of the prostatic urethra (not contiguous). PATIENTS AND METHODS Between 1992 and 2006, 351 men had RC for BC by one surgeon at our centre; they were stratified into those with contiguous or non‐contiguous disease, based on prostatic stromal involvement. Relevant clinical and pathological data were collected and the survival analysed. RESULTS In all, 24% (78/320) of the patients who had RC had prostatic involvement; 29 (9%) and 49 (15%) had contiguous and non‐contiguous involvement, respectively. In the non‐contiguous group, there was stromal and non‐stromal UC involvement in 18 (37%) and 31 (63%), respectively. The overall 5‐year survival of contiguous, non‐contiguous and no prostatic involvement was 6%, 57% and 66% (P < 0.001). The 5‐year overall survival of stromal and non‐stromal UC was 26% and 74% (P = 0.008). There was no statistical difference in survival between contiguous and non‐contiguous stromal involvement (P = 0.58). CONCLUSIONS Prostatic UC with no stromal involvement did not alter the survival predicted by the primary bladder stage. Stromal involvement of the prostate has a poor prognosis regardless of the mode of invasion.

Impact of the level of urothelial carcinoma involvement of the prostate on survival after radical cystectomy

“…Our findings confirm previous literature assessing the impact of UPI on survival outcomes in radical cystoprostatectomy patients [7,8,[11][12][13][14]. Knoedler et al [8] reported data of 201 patients treated at a single center between 1980 and 2006 who harbored UPI.…”

“…With the aim to improve sexual and functional outcomes, several prostate-sparing cystectomy techniques have been proposed [3][4][5][6]. However, the high incidence and potentially poor prognosis of urothelial carcinoma involvement of the prostate (UPI) makes these approaches too risky for widespread use [7][8][9][10].…”

“…Several authors reported incidence and survival implications of patients affected by UPI treated with radical cystoprostatectomy [7,8,[11][12][13][14]. Depth of tumor involvement was significantly associated with survival outcomes [8], although this was evident only with prostatic stromal invasion [7].…”

“…However, only a minority of studies investigated the differential impact of different levels of UPI [7,8].…”

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

“…132 Staging studies are recommended if there is invasion into ducts, acini, or stroma, as it may alter the prognosis and management. [133][134][135][136] B. Recommendations for management i.…”