Outcomes Of Patients Undergoing Radical Cystoprostatectomy For Bladder Cancer With Prostatic Involvement On Final Pathology

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer;  Cancer / Oncology
Article Date: 03 Aug 2009 - 2:00 PDT

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UroToday.com - Urothelial carcinoma (UC) can invade the prostate in men with bladder cancer. In fact, it is found in 15%-48% of cystoprostatectomy specimens from patients with bladder cancer.

Prostatic involvement of UC can occur via different routes (by growing transmurally through the bladder wall, or by pagetoid spread along the mucosal surface of the prostatic urethra) and can invade to various depths (superficial, ductal or stromal). We hypothesized that the different sites of origin and depths of invasion may confer different prognosis.

Our study was a retrospective review of 463 consecutive male patients treated with radical cystoprostatectomy for UC of the bladder. We found that 162 (35%) of patients had UC of the prostate, of which 124 (76%) arose in the prostatic urethra and 38 (24%) arose in the bladder and grew through the bladder wall into the prostate. By depth of invasion, 74 (60%) were superficial, 29 (23%) were ductal and 21 (17%) were stromal.

Patients with stromal depth invasion fared far worse that patients with more superficial UC of the prostate (p<0.001). Men with prostatic UC of prostatic origin had superior 3-year overall survival than men with bladder origin UC (51.0% vs. 6.7%, p<0.001 by log rank test). However, it was clear that depth of invasion was responsible for this difference; 3-year overall survival was similar in patients with stromal invasion regardless of the site of origin (6.7% for bladder origin vs. 16.8% for prostatic urethral origin, p=0.614).

Our finding, that survival is related to depth of invasion in men with prostatic UC at the time of radical cystoprostatectomy for bladder cancer, is important, because it suggests that prostatic involvement cannot be grouped together as a single entity. Rather, it will be important for future staging systems to take into account the findings in the prostate, particularly, the depth of invasion of UC.

Written by Daniel A. Barocas, MD as part of Beyond the Abstract on UroToday.com.

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