Prostatic involvement by transitional cell carcinoma: pathogenesis, patterns and prognosis

Bacillus Calmette-Guerin for treatment of superficial transitional cell carcinoma of the bladder in patients who have failed thiotepa and/or mitomycin C

Thirty patients with stage Ta carcinoma in situ or T1 superficial bladder cancer received 6 weeks of intravesical bacillus Calmette-Guerin. All patients had persistent or recurrent tumor despite thiotepa and/or mitomycin C. Response was determined by the results of endoscopy, bladder wash cytology and biopsy performed 4 weeks after the last dose of bacillus Calmette-Guerin. Of the 30 patients 15 (50 per cent) had a complete response. The likelihood of a complete response was better for those with initial Ta lesions (62 per cent) and carcinoma in situ (56 per cent) than for patients with an initial T1 lesion (25 per cent). Although the longest followup is only 36 months (mean 16 months) patients with a complete response have a much better prognosis in terms of subsequent tumor, need for cystectomy and death of bladder cancer.

Prostatic involvement in bladder cancer. Prostate mapping in 20 cystoprostatectomy specimens

Twenty prostate glands from patients with either high-grade papillary tumors (19 patients, 15 of whom also had peripheral carcinoma in situ) or multifocal carcinoma in situ (1 patient) of the bladder who underwent cystoprostatectomy were studied histologically by mapping. Prostatic duct involvement by urothelial carcinoma was noted in nine patients, two with extensive involvement and seven with focal involvement confined to periurethral ducts. Carcinoma in situ of the bladder was observed in each of the nine patients and intraepithelial permeation appeared to be the predominant manner of spread of cancer cells into the prostate. The prostatic involvement was clinically silent and it may be a potential source of failure of conservative modalities of treatment of high-grade bladder cancer. A routine diagnostic transurethral prostatic biopsy may be recommended in the workup of patients with carcinoma in situ and high-grade carcinomas of the bladder. An incidental observation was the presence of 14 occult prostatic adenocarcinomas.

Primary transitional cell carcinoma of prostatic periurethral ducts

Primary transitional cell carcinoma of the prostatic periurethral ducts is a distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.

Prostatic biopsy in selected patients with carcinoma in situ of the bladder: preliminary report

Transitional cell carcinoma was found in biopsies of grossly normal-appearing prostates in 4 of 40 patients with recurrent carcinoma in situ of the bladder. In selected patients prostatic biopsy may be warranted if conservative therapy does not control the bladder tumors and if cystectomy is contemplated.

The clinicopathological features of metastatic superficial papillary bladder cancer

A review of the records of more than 1,000 patients with bladder cancer has led to the identification of 9 with superficial papillary tumors and no evidence of muscle invasion in whom distant metastases developed. The majority of these patients had multiple recurrent tumors that were difficult to control by endoscopic means and failed to respond to intravesical chemotherapy, Helmstein's therapy or radiotherapy. Of the patients 4 had superficial tumors in the prostatic ducts but no stromal invasion. In 7 patients with well or moderately differentiated tumors the histological grade was the same in the metastases. The sites of metastases were bone in 5 patients, lung in 3 and liver in 1, which suggested hematogenous spread of tumor. Histological evidence of microvascular invasion was seen in 2 of the resected bladder tumors. We conclude that failure to control bladder tumors by local means should be an indication for early cystectomy, even in patients with no evidence of muscle invasion.

Postoperative radiation therapy for muscle-invading bladder carcinoma

From 1974-1980, 15 patients with pT2-4 bladder carcinoma received adjuvant postoperative radiation therapy (XRT). The extent of initial surgery varied (six radical cystectomy, 5 partial cystectomy, four "total" transurethral resection). The planned XRT was 4,000-5,040 rads in 5-6 weeks to the pelvis (achieved in 14/15 patients) followed by a bladder boost in noncystectomized patients (achieved in 8/9). Survival at two years and five years was 54% (7/13 patients) and 27% (3/11 patients), respectively. Local-regional disease control (minimum two-year follow-up) was achieved in 7/11 (63%). Of seven patients alive at least two years later, small bowel complications (chronic diarrhea, obstruction) occurred in two; these latter patients each had had radical cystectomy. Adjuvant postoperative XRT may be useful in the multimodality management of patients with bladder carcinoma, especially those identified as high risk after pathologic staging and initial surgery. The poor regional control rate and relatively high incidence of complications seen in this and previous studies suggest that improved radiation technique is needed, both to ensure adequate coverage of the volume at risk and to minimize complications. Representative portals are shown to illustrate these features.

Transitional cell carcinoma involving the prostate

Transitional cell carcinoma involving the prostate gland was studied in 27 patients. Three different groups were recognised on the basis of the clinical pattern and histological findings. Each group has a different prognosis and merits a different approach to treatment. Thus, stromal involvement of the prostate by transitional cell carcinoma is a sinister finding that requires radical treatment, whereas ductal involvement by either carcinoma in situ or non-invasive papillary tumours can be managed less aggressively. This study emphasises that the present classification for these tumours is unsatisfactory and that adequate histopathological information is essential for their management.

The management of transitional cell carcinoma in the prostate

Transitional cell carcinoma of the prostate is a rare tumour. A review of 318 patients with carcinoma of the prostate presenting to this hospital in the 5 years between April 1974 and April 1979 revealed 7 patients with transitional cell carcinoma arising within the prostate. Two of these had previously been treated for a transitional cell carcinoma of the bladder. These prostatic tumours are usually poorly differentiated and carry a poor prognosis. Early radical surgery, however, achieved a good result in one of our patients. Other forms of treatment were ineffective and a review of the literature revealed that this was also the experience of others. We suggest that cystoprostatectomy should be considered as an early form of treatment.

Transitional cell carcinoma of the prostate

Thirty-three cases of transitional cell carcinoma involving the prostate gland are reviewed. Four different types of involvement are described. The mortality of 66% was largely confined to those with primary prostatic transitional cell carcinoma and those in whom there was direct invasion of the prostate by a bladder tumour. The relationship of some of these lesions to urothelial carcinoma in situ is discussed.

Transitional cell carcinoma: cause of refractory cancer of prostate

Four cases with a diagnosis of adenocarcinoma of the prostate are presented in which a histologic pattern of adenocarcinoma mixed with transitional cell carcinoma developed subsequently. Suggestions are made regarding the pathogenesis and diagnosis.