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Takeuchi M, Tamada T, Higaki A, Kojima Y, Ueno Y, Yamamoto A. Pictorial review of the diagnosis of muscle-invasive bladder cancer using vesical imaging-reporting and data system (VI-RADS). Abdom Radiol (NY) 2024:10.1007/s00261-024-04424-3. [PMID: 38900320 DOI: 10.1007/s00261-024-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
The Vesical Imaging-Reporting and Data System (VI-RADS) is a standard magnetic resonance imaging (MRI) and diagnostic method for muscle-invasive bladder cancer that was published in 2018. Several studies have demonstrated that VI-RADS has high diagnostic power and reproducibility. However, reading VI-RADS requires a certain amount of expertise, and radiologists need to be aware of the various pitfalls. MRI of the bladder includes T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). T2WI is excellent for understanding anatomy. DWI and DCEI show high contrast between the tumor and normal anatomical structures and are suitable for staging local tumors. Bladder tumors are classified into five categories according to their size and morphology and their positional relationship to the bladder wall based on the VI-RADS diagnostic criteria. If the T2WI, DWI, and DCEI categories are the same, the category is the VI-RADS category. If the categories do not match, the DWI category is the VI-RADS category. If image quality of DWI is not evaluable, the DCEI category is the final category. In many cases, DWI is dominant, but this does not mean that T2WI and DCEI can be omitted from the reading of the bladder. In this educational review, typical and atypical teaching cases are demonstrated, and how to resolve misdiagnosis and the limitations of VI-RADS are discussed. The most important aspect of VI-RADS reading is to practice multiparametric reading with a solid understanding of the characteristics and role of each sequence and an awareness of the various pitfalls.
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Affiliation(s)
- Mitsuru Takeuchi
- Department of Radiology, Radiolonet Tokai, 3-86-2, Asaoka-Cho, Chikusa-Ku, Nagoya, Aichi, 464-0811, Japan.
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan.
| | - Tsutomu Tamada
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Atsushi Higaki
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yuichi Kojima
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Akira Yamamoto
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
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2
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Yu J, Lee CU, Chung JH, Song W, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Sung HH. Impact of urinary diversion type on urethral recurrence following radical cystectomy for bladder cancer: propensity score matched and weighted analyses of retrospective cohort. Int J Surg 2024; 110:700-708. [PMID: 38000052 PMCID: PMC10871635 DOI: 10.1097/js9.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The absence of randomized controlled trials and the presence of inherent selection bias in existing studies have led to ongoing uncertainty regarding the impact of urinary diversion (UD) type (orthotopic UD or nonorthotopic UD) on urethral recurrence (UR) following radical cystectomy (RC) for bladder cancer. This study aimed to assess the impact of the UD types on UR after RC and to identify predictive factors associated with UR. MATERIALS AND METHODS This retrospective analysis encompassed 612 male patients who underwent RC for urothelial carcinoma of the bladder. Among them, 341 patients received nonorthotopic UD [ileal conduit (IC) or ureterocutaneostomy (UC)], whereas 271 received orthotopic neobladder (NB) between January 2012 and October 2022. To mitigate potential biases, we employed 1:1 propensity score matching (PSM) and stabilized inverse probability treatment weighting (IPTW). Kaplan-Meier analysis and log-rank tests were employed to assess UR-free survival between the IC/UC and NB groups, while multivariable Cox regression analysis was conducted to determine predictive factors for UR. RESULTS Among the 612 patients included, 33 (5.4%) experienced UR. PSM yielded matched cohort comprising 412 patients, evenly distributed with 206 patients in each group (IC/UC and NB). Clinicopathological data demonstrated similarity between the two groups. Patients who underwent NB exhibited significantly superior UR-free survival in both PSM (log-rank P =0.033) and IPTW cohorts (log-rank P =0.009). NB reconstruction (vs. IC/UC) emerged as a substantial protective factor against UR [hazard ratio (HR) 0.283; 95% CI: 0.088-0.916; P =0.035], whereas prostatic urethral involvement was identified as a significant risk factor (HR 5.328; 95% CI: 1.298-21.868; P =0.020) in the PSM cohort. Additionally, in the IPTW cohort, NB reconstruction (vs. IC/UC) maintained its significance as a protective factor against UR (HR 0.336; 95% CI: 0.131-0.858; P =0.023) along with neoadjuvant chemotherapy (HR 0.335; 95% CI: 0.116-0.969; P =0.044), whereas prostatic urethral involvement remained a significant risk factor (HR 3.752; 95% CI: 1.484-9.488; P =0.005). CONCLUSIONS Even after mitigating selection bias, NB reconstruction holds a protective effect against UR in male patients undergoing RC for bladder cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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3
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Zhan X, Guo J, Chen L, Deng W, Liu X, Zhu K, Liu W, Fu B. Prognostic significance of bladder neck involvement in non-muscle-invasive bladder cancer: A SEER database analysis with 19,919 patients. Cancer Med 2021; 10:6868-6880. [PMID: 34423585 PMCID: PMC8495274 DOI: 10.1002/cam4.4219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To study prognostic values of bladder neck involvement (BNI) and survival outcomes in non-muscle-invasive bladder cancer (NMIBC). METHOD AND MATERIALS The national Surveillance, Epidemiology, and End Results database (2004-2015) was applied to gain further insight into the prognostic values of BNI and 19,919 patients diagnosed with NMIBC were included in our study. We used the Kaplan-Meier method with the log-rank test and subgroup analyses to evaluate cancer-specific survival (CSS) and overall survival (OS). In addition, the multivariable Cox proportional hazard model and propensity score matching (PSM) were utilized. RESULTS In all, 3446 patients with BNI and 16,473 patients with sites except for bladder neck were enrolled in our study. Compared with other sites, a tendency toward a higher proportion of higher grade (p < 0.001), bigger tumor size (p < 0.001), and more patients with T1 and Tis stage (p < 0.001) was seen in BNI group. After 1:1 PSM, 3425 matched pairs were selected. Under the survival analyses, the BNI group had a lower survival probability in both OS (p = 0.0056) and CSS analyses (p < 0.0001) in NMIBC patients. However, in the subgroup analysis, only observed in the Ta and T1 stage in terms of CSS (all p < 0.05), and patients with Tis stage failed to show statistical survival differences (p > 0.05). In addition, subgroups stratified by tumor size and grade all revealed poor prognosis of BNI in NMIBC patients. Moreover, better survival outcomes of OS were observed in BNI patients who received radical cystectomy (p = 0.02) or chemotherapy (p < 0.001) multivariable Cox regression after PSM revealed that the BNI group had a higher risk of overall mortality (OM) (BNI vs. other sites hazards ratios [HR]: 1.127, 95% CI: 1.154-1.437, p < 0.001) and cancer-specific mortality (CSM) (BNI vs. other sites HR: 1.127, 95% CI: 1.039-1.223, p < 0.001), while before PSM, similar situations were only existed in CSM (BNI vs. other sites HR: 1.288, 95% CI: 1.154-1.437, p < 0.001). CONCLUSIONS The prognosis of BNI was poorer than that of the other sites. BNI was an independent risk factor for OM and CSM in patients with NMIBC, especially for those with Ta or T1 stage.
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Affiliation(s)
- Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Ke Zhu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Inst Urol, Nanchang, Jiangxi, P. R. China
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Fukushima H, Moriyama S, Waseda Y, Fukuda S, Uehara S, Tanaka H, Kijima T, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Fujii Y. Significance of Bladder Neck Involvement in Risk Substratification of Intermediate-Risk Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2020; 7:366-372. [PMID: 31987764 DOI: 10.1016/j.euf.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intermediate-risk non-muscle-invasive bladder cancer (NMIBC) involves heterogeneous patients, resulting in uncertainty regarding its prognosis and the indication of adjuvant therapy. Previous studies suggested a correlation between tumor location, especially bladder neck involvement (BNI), and patient prognosis of NMIBC. OBJECTIVE We investigated the role of BNI in risk substratification of intermediate-risk NMIBC patients. DESIGN, SETTING, AND PARTICIPANTS This single-institutional study included 436 primary or recurrent intermediate-risk NMIBC patients based on risk stratification in the European Association of Urology guidelines. INTERVENTION All patients underwent transurethral resection of the bladder tumor. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary and secondary endpoints were progression and recurrence, respectively. The associations of BNI with the endpoints were examined using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS AND LIMITATIONS Overall, 205 (47%) patients had multiple tumors and 276 (63%) underwent intravesical therapy. BNI was observed in 53 (12%) patients. During the median follow-up of 42 mo, 12 (3%) and 211 (48%) patients experienced progression and recurrence, respectively. Multivariate analysis showed that BNI was an independent predictor for both progression (hazard ratio 10.98, p < 0.001) and recurrence (hazard ratio 2.12, p < 0.001). The progression rate was significantly higher in patients with BNI compared with those without BNI (13% vs 1% at 3 yr and 20% vs 1% at 6 yr; p < 0.001). Analogous findings were observed for recurrence. The progression rate was more remarkably stratified by BNI in 103 recurrent cases (17% vs 3% at 3 yr and 34% vs 3% at 6 yr in patients with vs without BNI; p < 0.001). A limitation of this study was its retrospective nature. CONCLUSIONS BNI substratified intermediate-risk NMIBC patients well regarding their risks of progression and recurrence, which could help determine follow-up and therapeutic strategies for these patients. PATIENT SUMMARY The associations of bladder neck involvement with progression and recurrence were evaluated in patients with intermediate-risk non-muscle-invasive bladder cancer. We found that bladder neck involvement was a good factor for substratifying patients based on their risks of progression and recurrence. Bladder neck involvement can be useful in determining follow-up and therapeutic strategies for intermediate-risk non-muscle-invasive bladder cancer.
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Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shingo Moriyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
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Dataset for the reporting of carcinoma of the bladder-cystectomy, cystoprostatectomy and diverticulectomy specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2020; 476:521-534. [PMID: 31915958 DOI: 10.1007/s00428-019-02727-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) is a not for profit organisation whose goal is to produce standardised internationally agreed and evidence-based datasets for pathology reporting. With input from pathologists worldwide, the datasets are intended to be uniform and structured. They include all items necessary for an objective and accurate pathology report which enables clinicians to apply the best treatment for the patient. This dataset has had input from a multidisciplinary ICCR expert panel. The rationale for some items being required and others recommended is explained, based on the latest literature. The dataset incorporates data from the World Health Organization (WHO) 2016, and also from the latest (8th edition) TNM staging system of the American Joint Committee on Cancer (AJCC). Fifteen required elements and eight recommended items are described. This dataset provides all the details for a precise and valuable pathology report required for patient management and prognostication. This dataset is intended for worldwide use, and should facilitate the collection of standardised comparable data on bladder carcinoma at an international level.
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6
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Chen J, Miranda G, Cai J, Daneshmand S, Djaladat H. Preoperative chemotherapy for prostatic stromal invasive urothelial bladder cancer: comparison of oncological outcomes of male patients with cT4a disease undergoing radical cystectomy with or without preoperative chemotherapy. Scand J Urol 2019; 53:123-128. [PMID: 31081431 DOI: 10.1080/21681805.2019.1613445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The value of preoperative chemotherapy to prostatic stromal invasive urothelial bladder cancer remains uncertain. This study presented the pathological response and oncological outcomes of male patients with cT4a urothelial bladder cancer managed with preoperative chemotherapy followed by radical cystectomy. Materials and methods: Data were collected retrospectively from male patients with cT4a urothelial bladder cancer, who underwent radical cystectomy with or without preoperative chemotherapy. Patient characteristics and pathological response were compared. The Kaplan-Meier method and multivariable Cox regression were used to analyze recurrence-free survival and overall survival. Results: From 1989 to 2016, 90 male patients with primary cT4a urothelial bladder cancer underwent radical cystectomy at the institution, 55 (61%) did not have preoperative chemotherapy and 35 (39%) had preoperative chemotherapy. The preoperative chemotherapy group had more lymphovascular invasion on primary transurethral resection of bladder tumor (31.4% vs 18.2%, p = .2) and more clinically positive nodal disease (31.4% vs 10.9%, p = .09). At radical cystectomy, the preoperative chemotherapy group had more tumor down staging (60% vs 29.1%, p = .005), less lymphovascular invasion (40% vs 54.5%, p = .05) and less positive nodal disease (25.7% vs 45.5%, p = .006). Hydronephrosis, lymphovascular invasion and age >70 were associated with worse recurrence-free survival and overall survival (p < .05). Tumor down-staging was associated with improved recurrence-free survival and overall survival (p = .003, p = .03, respectively). Preoperative chemotherapy alone was not associated with improved oncologic outcomes. Conclusions: Preoperative chemotherapy is associated with cT4a bladder cancer down-staging, decreased lymphovascular invasion and decreased positive nodal disease. Preoperative chemotherapy provides survival benefit to those who achieved pathological response.
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Affiliation(s)
- Jian Chen
- a Catherine & Joseph Aresty Department of Urology , University of Southern California Institute of Urology , Los Angeles , CA , USA
| | - Gus Miranda
- a Catherine & Joseph Aresty Department of Urology , University of Southern California Institute of Urology , Los Angeles , CA , USA
| | - Jie Cai
- a Catherine & Joseph Aresty Department of Urology , University of Southern California Institute of Urology , Los Angeles , CA , USA
| | - Siamak Daneshmand
- a Catherine & Joseph Aresty Department of Urology , University of Southern California Institute of Urology , Los Angeles , CA , USA
| | - Hooman Djaladat
- a Catherine & Joseph Aresty Department of Urology , University of Southern California Institute of Urology , Los Angeles , CA , USA
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7
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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Challenges in Pathologic Staging of Bladder Cancer: Proposals for Fresh Approaches of Assessing Pathologic Stage in Light of Recent Studies and Observations Pertaining to Bladder Histoanatomic Variances. Adv Anat Pathol 2017; 24:113-127. [PMID: 28398951 DOI: 10.1097/pap.0000000000000152] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paradigm of pathologic stage (pT) categorization in bladder cancer remains the depth of invasion into the different histologic layers of the bladder wall. However, the approaches to assigning pT stage category toward an enhanced outcome stratification have been marked by challenges and innovations, due in part to our growing appreciation of the surprisingly perplexing bladder histoanatomy. Upstaging of pT1 tumors after radical cystectomy is substantial and underscores the potential value of pT1 substaging in transurethral resection (TUR) specimens. The 2017 American Joint Committee on Cancer tumor-node-metastasis system recommends pT1 substaging but recognizes the need to optimize the approach. Over the years, the cut-off for microinvasion has been significantly lowered to 0.5 mm and is now a promising scheme for pT1 (micrometric) substaging. Unlike the micrometric approach, histoanatomic substaging using muscularis mucosae (MM) and vascular plexus as landmarks is less feasible in TUR specimens and inconsistent in stratifying the outcome of pT1 tumors. The lamina propria possesses inherent variations in depth, MM, and vascular plexus dispositions that should be factored in future pT1 substaging proposals. Histoanatomic variations among the bladder regions also occur, and studies suggest that trigone and bladder neck cancers may have more adverse outcomes. The muscularis propria (MP), besides being the essential histologic landmark for assigning pT2 stage category, is also considered a surrogate for the adequacy of TUR, furthering the importance of identifying its presence in TUR specimens. MP, however, may be mimicked by hyperplastic or isolated MP-like MM muscle bundles in the lamina propria with overstaging implications, and caution should be exercised in distinguishing these 2 muscle types morphologically and immunohistochemically. Presence of additional superficial MP unique from the detrusor muscle proper may also complicate staging at the trigone and ureter insertion sites. With regard to the depth of MP invasion, large and multicenter studies have reaffirmed the prognostic significance of pT2a/b subcategories. It is revealed that there are at least 3 ways used to demarcate the irregular MP to perivesical soft tissue junction, and use of a common criterion indicates improvement in pT2b/pT3a staging reproducibility. Although studies have shown significantly poorer outcome in pT3b compared with pT3a tumors, this designation has a substantial reliance on the prosector's gross assessment of perivesical soft tissue invasion which if performed incorrectly may lead to staging inaccuracy of pT3 tumors. The 8th edition of the American Joint Committee on Cancer has updated the staging schema for bladder cancers with concomitant prostatic stromal invasion and cancers within bladder diverticula. Because of 2 possible pT designations, prostatic stromal invasion in TUR specimens should not be automatically staged as either pT4a or pT2 (urethral). Recent data support that bladder cancer invading into the seminal vesicle has comparable outcome to pT4b tumors. Interestingly, several studies in pT4a tumors, which are staged based on sex-specific organs, have shown poorer outcome in females than males after radical cystectomy, and while there are possibly several reasons, they may also include anatomic factors. Despite the progress has been made, work remains to be done to inform future bladder cancer pT category definitions and their reproducibility in application and prognostication.
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9
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Vallo S, Gilfrich C, Burger M, Volkmer B, Boehm K, Rink M, Chun FK, Roghmann F, Novotny V, Mani J, Brisuda A, Mayr R, Stredele R, Noldus J, Schnabel M, May M, Fritsche HM, Pycha A, Martini T, Wirth M, Roigas J, Bastian PJ, Nuhn P, Dahlem R, Haferkamp A, Fisch M, Aziz A. Comparative analysis of the effect of prostatic invasion patterns on cancer-specific mortality after radical cystectomy in pT4a urothelial carcinoma of the bladder. Urol Oncol 2016; 34:432.e1-8. [PMID: 27283218 DOI: 10.1016/j.urolonc.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the prognostic relevance of different prostatic invasion patterns in pT4a urothelial carcinoma of the bladder (UCB) after radical cystectomy. MATERIALS AND METHODS Our study comprised a total of 358 men with pT4a UCB. Patients were divided in 2 groups-group A with stromal infiltration of the prostate via the prostatic urethra with additional muscle-invasive UCB (n = 121, 33.8%) and group B with continuous infiltration of the prostate through the entire bladder wall (n = 237, 66.2%). The effect of age, tumor grade, carcinoma in situ, lymphovascular invasion, soft tissue surgical margin, lymph node metastases, administration of adjuvant chemotherapy, and prostatic invasion patterns on cancer-specific mortality (CSM) was evaluated using competing-risk regression analysis. Decision curve analysis was used to evaluate the net benefit of including the variable invasion pattern within our model. RESULTS The estimated 5-year CSM-rates for group A and B were 50.1% and 66.0%, respectively. In multivariable competing-risk analysis, lymph node metastases (hazard ratio [HR] = 1.73, P<0.001), lymphovascular invasion (HR = 1.62, P = 0.0023), soft tissue surgical margin (HR = 1.49, P = 0.026), absence of adjuvant chemotherapy (HR = 2.11, P<0.001), and tumor infiltration of the prostate by continuous infiltration of the entire bladder wall (HR = 1.37, P = 0.044) were significantly associated with a higher risk for CSM. Decision curve analysis showed a net benefit of our model including the variable invasion pattern. CONCLUSIONS Continuous infiltration of the prostate through the entire bladder wall showed an adverse effect on CSM. Besides including these patients into clinical trials for an adjuvant therapy, we recommend including prostatic invasion patterns in predictive models in pT4a UCB in men.
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Affiliation(s)
- Stefan Vallo
- Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Björn Volkmer
- Department of Urology, Kassel Medical Center, Kassel, Germany
| | - Katharina Boehm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Vladimir Novotny
- Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany
| | - Jens Mani
- Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Antonin Brisuda
- Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Roman Mayr
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Urology, General Hospital of Bolzano, Bolzano, Italy
| | - Regina Stredele
- Department of Urology, Kassel Medical Center, Kassel, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marco Schnabel
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Armin Pycha
- Department of Urology, General Hospital of Bolzano, Bolzano, Italy
| | - Thomas Martini
- Department of Urology, General Hospital of Bolzano, Bolzano, Italy; Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany
| | - Jan Roigas
- Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany
| | - Patrick J Bastian
- Department of Urology, Marien Hospital Düsseldorf, Düsseldorf, Germany
| | - Philipp Nuhn
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Haferkamp
- Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Atiqullah Aziz
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Capek S, Howe BM, Amrami KK, Spinner RJ. Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus 2015; 39:E14. [DOI: 10.3171/2015.7.focus15209] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist.
METHODS
The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. All available history, physical examination, electrodiagnostic studies, biopsy data and imaging studies, evidence of other metastatic disease, and follow-up were recorded in detail. The series was divided into 2 groups: cases with neoplastic lumbosacral plexopathy confirmed by biopsy (Group A) and cases included based on imaging characteristics despite the lack of biopsy or negative biopsy results (Group B).
RESULTS
Group A comprised 10 patients (mean age 69 years); 9 patients were symptomatic and 1 was asymptomatic. The L5–S1 spinal nerves and sciatic nerve were most frequently involved. Three patients had intradural extension. Seven patients were alive at last follow-up. Group B consisted of 7 patients (mean age 64 years); 4 patients were symptomatic, 2 were asymptomatic, and 1 had only imaging available. The L5–S1 spinal nerves and the sciatic nerve were most frequently involved. No patients had intradural extension. Four patients were alive at last follow-up.
CONCLUSIONS
The authors provide a unifying theory to explain lumbosacral plexopathy in select cases of various pelvic neoplasms. The tumor cells can use splanchnic nerves as conduits and spread from the end organ to the lumbosacral plexus. Tumor can continue to spread along osseous and muscle nerve branches, resulting in muscle and bone “metastases.” Radiological studies show a reproducible, although nonspecific pattern, and the same applies to clinical presentation.
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Affiliation(s)
- Stepan Capek
- Departments of 1Neurosurgery and
- 22nd Faculty of Medicine, Charles University in Prague, Czech Republic
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11
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Knoedler JJ, Boorjian SA, Tollefson MK, Cheville JC, Thapa P, Tarrell RF, Frank I. Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy. BJU Int 2014; 114:832-6. [DOI: 10.1111/bju.12486] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Prabin Thapa
- Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | - Robert F. Tarrell
- Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | - Igor Frank
- Department of Urology; Mayo Clinic; Rochester MN USA
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12
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May M, Brookman-May S, Burger M, Gilfrich C, Fritsche HM, Rink M, Chun F, Fisch M, Roghmann F, Noldus J, Mayr R, Pycha A, Novotny V, Wirth M, Vallo S, Haferkamp A, Roigas J, Brisuda A, Stredele R, Volkmer B, Dechet C, Schnabel M, Denzinger S, Stief CG, Bastian PJ, Aziz A. Concomitant seminal vesicle invasion in pT4a urothelial carcinoma of the bladder with contiguous prostatic infiltration is an adverse prognosticator for cancer-specific survival after radical cystectomy. Ann Surg Oncol 2014; 21:4034-40. [PMID: 24895114 DOI: 10.1245/s10434-014-3827-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series. METHODS A total of 385 patients with UCB and contiguous prostatic infiltration comprised our study. Patients were divided in two groups according to cSVI. Median follow-up was 36 months (interquartile range 11-74); the primary end point was cancer-specific mortality. The prognostic impact of cSVI was evaluated using multivariable Cox regression analysis. The predictive accuracy was assessed by a receiver operating characteristic analysis. RESULTS A total of 229 patients (59.5 %) without cSVI comprised group A, and 156 patients (40.5 %) with cSVI comprised group B. Positive lymph nodes (63 vs. 44 %, p < 0.001) and positive surgical margins (34 % vs. 14 %, p < 0.001) were more common in patients with cSVI. The 5- and 10-year cancer-specific survival rates were 41 % and 32 % (group A) and 21 and 17 % (group B) (p < 0.001). In multivariable analysis, pathological nodal stage (hazard ratio [HR] 2.19, p < 0.001), soft tissue surgical margin (HR 1.57, p = 0.010), clinical tumor stage (HR 1.46, p = 0.010), adjuvant chemotherapy (HR 0.40, p < 0.001), and cSVI (HR 1.69, p < 0.001) independently impacted cancer-specific mortality. The c-indices of the multivariable models with and without inclusion of cSVI were 0.658 (95 % confidence interval 0.60-0.71) and 0.635 (95 % confidence interval 0.58-0.69), respectively, resulting in a predictive accuracy gain of 2.3 % (p = 0.002). CONCLUSIONS In patients with UCB and prostatic stromal invasion, cSVI adversely affected cancer-specific survival compared to patients without cSVI. The inclusion of cSVI significantly improved the predictive accuracy of our multivariable model regarding survival.
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Affiliation(s)
- Matthias May
- Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany
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13
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Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, Fradet Y, Hautmann RE, Lee CT, Lerner SP, Pycha A, Sievert KD, Stenzl A, Thalmann G, Shariat SF. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 2014; 113:11-23. [PMID: 24330062 DOI: 10.1111/bju.12121] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT The urinary reconstructive options available after radical cystectomy (RC) for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options. OBJECTIVE To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma. EVIDENCE ACQUISITION A Medline search was conducted to identify original articles, review articles, and editorials on urinary diversion in patients treated with RC. Searches were limited to the English language. Keywords included: 'bladder cancer', 'cystectomy', 'diversion', 'neobladder', and 'conduit'. The articles with the highest level of evidence were selected and reviewed, with the consensus of all of the authors of this paper. EVIDENCE SYNTHESIS Both continent and incontinent diversions are available for urinary reconstruction after RC. In appropriately selected patients, an orthotopic neobladder permits the elimination of an external stoma and preservation of body image without compromising cancer control. However, the patient must be fully educated and committed to the labour-intensive rehabilitation process. He must also be able to perform self-catheterisation if necessary. When involvement of the urinary outflow tract by tumour prevents the use of an orthotopic neobladder, a continent cutaneous reservoir may still offer the opportunity for continence albeit one that requires obligate self-catheterisation. For patients who are not candidates for continent diversion, the ileal loop remains an acceptable and reliable option. CONCLUSIONS Both continent and incontinent diversions are available for urinary reconstruction after RC. Orthotopic neobladders optimally preserve body image, while continent cutaneous diversions represent a reasonable alternative. Ileal conduits represent the fastest, easiest, least complication-prone, and most commonly performed urinary diversion.
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Affiliation(s)
- Richard K Lee
- James Buchanan Brady Foundation, Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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14
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Accurate determination of the pathological stage with gross dissection protocol for radical cystectomy. Pathol Oncol Res 2014; 20:677-85. [PMID: 24563275 DOI: 10.1007/s12253-014-9748-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
The current protocol for reporting urinary bladder cancer in radical cystectomies may exhibit limitations in the diagnostic accuracy, such as a risk of understaging, especially in cases with prostatic involvement. Difficulty can arise in the verification of stage pT0, and the assessment of surgical margins is suboptimal. We have developed a daily gross dissection protocol practice where radical cystectomies are totally embedded and evaluated histologically in whole-mount sections. We report here on the first 138 consecutive specimens from 2008 to the first quarter of 2012 inclusive. The incidence of the cancer stages was compared with data on 15,586 radical cystectomies from the literature. The differences were analyzed with the one-sample z-test (p < 0.05). The following emerged from and our series and the literature data: pT0 8.7 % and 6.1 %; pTa 0.7 % and 2.9 %; pTis 2.9 % and 6 %; pT1 15.2 % and 15.5 %; pT2 21 % and 23.3 %; pT3 34.8 % and 34.3 %; and pT4 16.7 % and 11 %, respectively. Our findings closely reflected the means of the published statistical data based on a large number of cases. The differences were due to the more detailed processing: the case numbers in groups from pTis to pT2 were comparatively low, while those in groups pT3 and pT4 were higher. The difference in group pT4 was significant (p = 0.0494). With this method, only those samples were regarded as pT0 in which the granulomatous area and the hemosiderin deposition indicative of the earlier intervention were observable and the entire preparation was tumor-free.
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15
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Takeuchi M, Sasaki S, Naiki T, Kawai N, Kohri K, Hara M, Shibamoto Y. MR imaging of urinary bladder cancer for T-staging: a review and a pictorial essay of diffusion-weighted imaging. J Magn Reson Imaging 2013; 38:1299-309. [PMID: 24265260 DOI: 10.1002/jmri.24227] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/26/2013] [Indexed: 01/24/2023] Open
Abstract
Treatment decisions for bladder cancer patients are mainly based on the depth of bladder wall invasion by the tumor. In this article, we review the conventional MRI and exhibit a recently emerged diffusion-weighted imaging (DWI) of urinary bladder cancer for T-staging. We discuss limitations of conventional MRI, scanning protocols of DWI, normal pelvic findings on DWI, determination of T-stage using DWI, and pitfalls of DWI. DWI provides high contrast between bladder cancer and background tissue because the cancer shows markedly high SI. DWI has high sensitivity for detecting the stalk seen in stage Ta or T1. An inflammatory change or fibrosis surrounding the tumor mimics the invasion of bladder cancer on T2-weighted imaging or enhanced MRI and could lead to over-staging, but DWI could differentiate them clearly because these benign changes do not show high SI on DWI. DWI is also useful for detecting ureteral, urethral, and prostatic extension by means of the urethra. DWI provides more accurate information on the extent of bladder cancer and contributes to determination of the treatment strategy.
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Affiliation(s)
- Mitsuru Takeuchi
- Nagoya City University, Graduate School of Medical Sciences and Medical school, Department of Radiology, Mizuho-ku, Nagoya, Japan
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16
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Hansel DE, Amin MB, Comperat E, Cote RJ, Knüchel R, Montironi R, Reuter VE, Soloway MS, Umar SA, Van der Kwast TH. A Contemporary Update on Pathology Standards for Bladder Cancer: Transurethral Resection and Radical Cystectomy Specimens. Eur Urol 2013; 63:321-32. [DOI: 10.1016/j.eururo.2012.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
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17
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Macek P, Sanchez-Salas R, Rozet F, Barret E, Galiano M, Hanus T, Cathelineau X. Prostate-Sparing Radical Cystectomy for Selected Patients with Bladder Cancer. Urol Int 2013; 91:89-96. [DOI: 10.1159/000348332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/18/2013] [Indexed: 11/19/2022]
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18
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Validation of New AJCC Exclusion Criteria for Subepithelial Prostatic Stromal Invasion from pT4a Bladder Urothelial Carcinoma. J Urol 2013; 189:53-8. [DOI: 10.1016/j.juro.2012.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Indexed: 11/23/2022]
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19
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Jones ML, Ewing CM, Isaacsa WB, Getzenberg RH. Prostate cancer-derived angiogenin stimulates the invasion of prostate fibroblasts. J Cell Mol Med 2012; 16:193-201. [PMID: 21352472 PMCID: PMC3823105 DOI: 10.1111/j.1582-4934.2011.01283.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Prostate fibroblasts promote prostate cancer progression by secreting factors that enhance tumour growth and induce the migration and invasion of prostate cancer cells. Considering the role of fibroblasts in cancer progression, we hypothesized that prostate cancer cells recruit these cells to their vicinity, where they are most directly available to influence cancer cell behaviour. To test this hypothesis, we performed modified Boyden chamber assays assessing the migration and collagen I invasion of normal primary prostate fibroblasts (PrSCs) and prostate cancer-associated fibroblasts (PCAFs) in response to media conditioned by the metastatic prostate cancer cell lines PC-3, LNCaP and DU145. During 4-hr incubations, PrSCs and PCAFs migrated and invaded in response to the conditioned media. To identify candidate proteins in the conditioned media that produced these effects, we performed cytokine antibody arrays and detected angiogenin in all three media. Angiogenin-blocked PC-3-conditioned medium, obtained using an anti-angiogenin polyclonal antibody or angiogenin siRNA, significantly reduced PC-3-induced PrSC and PCAF collagen I invasion. Furthermore, angiogenin alone at 1, 2 and 5 ng/ml significantly stimulated PCAF collagen I invasion. These results suggest that PC-3-derived angiogenin stimulates the invasion of normal prostate fibroblasts and PCAFs and is sufficient for invasion of the latter. Because prostate fibroblasts play key roles in prostate cancer progression, targeting their invasion using an anti-angiogenin-based therapy may be a strategy for preventing or treating advanced prostate cancer.
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Affiliation(s)
- Michelle L Jones
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Defining patient selection for prostate-sparing cystectomy in squamous cell carcinoma of the urinary bladder associated with bilharziasis: an overview of 236 patients. Urology 2011; 78:1351-4. [PMID: 22014965 DOI: 10.1016/j.urology.2011.06.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/10/2011] [Accepted: 06/04/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine possible risk factors associated with prostate invasion in patients with squamous cell carcinoma (SCC) of the urinary bladder associated with bilharziasis. METHODS After obtaining approval from the medical ethics committee, we reviewed the clinical and pathologic data from 236 male patients in our department between January 2006 and October 2010 who were treated with radical cystoprostatectomy and proved to have SCC associated with bilharziasis. We reviewed the clinical and histopathologic data regarding prostate infiltration from SCC of the urinary bladder associated with bilharziasis. RESULTS Two-hundred thirty-six patients were included in this study. Prostate infiltration was present in 14 patients (5.9%). Tumor located in the bladder neck (P = .000001), tumors >5 cm (P = .009), and advanced clinical tumor stage (P = .000001) were associated with highly statistically significant increased risk of prostate invasion from SCC of the urinary bladder. Different patients' ages, high tumor grade, and regional lymph nodes' metastasis were not associated with increased risk of prostate invasion from SCC of the urinary bladder. CONCLUSION Prostate infiltration from SCC of the urinary bladder (which is associated with bilharziasis) is not uncommon. Tumor >5 cm, bladder neck tumor, and high clinical tumor stages should be considered at least relative contraindications for prostate-sparing cystectomy.
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Segal R, Yafi FA, Brimo F, Tanguay S, Aprikian A, Kassouf W. Prognostic factors and outcome in patients with T1 high-grade bladder cancer: can we identify patients for early cystectomy? BJU Int 2011; 109:1026-30. [DOI: 10.1111/j.1464-410x.2011.10462.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Developing Selection Criteria for Prostate-sparing Cystectomy: A Review of Cystoprostatectomy Specimens. Urology 2010; 75:1116-20. [DOI: 10.1016/j.urology.2009.09.081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/01/2009] [Accepted: 09/12/2009] [Indexed: 10/20/2022]
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23
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Primary transitional cell carcinoma of the prostate: a male disease with dismal prognosis despite cisplatin-based systemic chemotherapy. JOURNAL OF MEN'S HEALTH 2010. [DOI: 10.1016/j.jomh.2009.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009; 455:449-53. [PMID: 19841937 DOI: 10.1007/s00428-009-0849-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/06/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
Abstract
Prostate involvement is a major prognostic element in urothelium carcinoma staging after radical cystoprostatectomy (RCP) for muscle invasive bladder cancer. While appropriate pTNM stage is necessary for adequate treatment, no standard procedure exists up to now for macroscopic sampling of the prostate in RCP in daily practice. We therefore propose a protocol where examination of the whole prostatic urethra (PU) is possible, without using whole mount sections. From 2008 to June 2009, RCP were sampled according to a macroscopic protocol permitting the whole length and the underlying stroma of PU to be visualized. Data were compared with our series or RCP from 2000-2007, when the PU was evaluated with a more simple protocol. One hundred and one specimens were examined between 2000-2007, 25 until June 2009. In the latter series, we found pT4 bladder cancer in 36% versus 21%, Cis in the PU in 28% versus 14%, and additional prostate cancer was seen in 44% compared with 13% (p = 0.0004) in the 2008-2009 group versus the 2000-2007 group, respectively. Our proposed protocol better detects prostate involvement by bladder cancer, therefore providing a better final stage of the patients. We propose a macroscopic protocol where the whole PU and the underlying stroma can be examined without the use of whole mount sections. Data are similar to those published in the recent literature, where whole mount sections were used. This protocol also permits better detection of concomitant prostate carcinomas.
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Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA, Cookson MS. Outcomes of patients undergoing radical cystoprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009; 104:1091-7. [DOI: 10.1111/j.1464-410x.2009.08558.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Liedberg F, Anderson H, Bläckberg M, Chebil G, Davidsson T, Gudjonsson S, Jahnson S, Olsson H, Månsson W. Prospective study of transitional cell carcinoma in the prostatic urethra and prostate in the cystoprostatectomy specimen. ACTA ACUST UNITED AC 2009; 41:290-6. [PMID: 17763219 DOI: 10.1080/00365590601183576] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the prostatic urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the prostatic urethra and prostate and examine the sensitivity of preoperative loop biopsies from the prostatic urethra. MATERIAL AND METHODS Preoperatively, patients were investigated with cold cup biopsies from the bladder and transurethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. RESULTS The incidence of TCC in the prostatic urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette-Guérin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the prostatic urethra/prostate. Cis, multifocal Cis (> or = 2 locations) and tumour location in the trigone were significantly more common in cystectomy specimens with TCC in the prostatic urethra and prostate: 21/50 (42%) vs 32/125 (26%), p=0.045; 20/50 (40%) vs 27/125 (22%), p=0.023; and 20/50 (40%) vs 26/125 (21%), p=0.01, respectively. Preoperative resectional biopsies from the prostatic urethra in the 154 patients analysed identified 31/47 (66%) of patients with TCC in the prostatic urethra/prostate, with a specificity of 89%. The detection of stromal-invasive and non-stromal involvement was similar: 66% and 65%, respectively. CONCLUSIONS The incidence of TCC in the prostatic urethra and prostate was 29% (50/175) in the cystoprostatectomy specimen. Preoperative biopsies from the prostatic urethra identified 66% of patients with such tumour growth. Our findings suggest that preoperative cold cup mapping biopsies of the bladder for detection of Cis add little extra information with regard to the risk of TCC in the prostatic urethra and prostate.
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Mazzucchelli R, Barbisan F, Santinelli A, Scarpelli M, Galosi AB, Lopez-Beltran A, Cheng L, Kirkali Z, Montironi R. Prediction of prostatic involvement by urothelial carcinoma in radical cystoprostatectomy for bladder cancer. Urology 2009; 74:385-90. [PMID: 19501882 DOI: 10.1016/j.urology.2009.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/06/2009] [Accepted: 03/10/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To ascertain which variables of bladder urothelial carcinoma (UC) might be useful in predicting either UC involving the prostate (UCP) or incidental prostate adenocarcinoma in radical cystoprostatectomy specimens. METHODS The bladder and whole-mount prostate sections of 248 radical cystoprostatectomy specimens were reviewed. Stepwise discriminant analysis was used to predict UCP or incidental prostate adenocarcinoma. RESULTS UCP was present in 94 patients (37.9%). UC originated from the prostatic urethra and periurethral ducts in 78 (31.45%), and isolated direct extension of UC from the bladder was present in 16 patients (6.45%). The periurethral ducts coexisted with direct extension of bladder UC in 11 patients (4.4%). Prostate adenocarcinoma was identified in 123 patients (49.6%). Carcinoma in situ and high-grade urothelial papillary carcinoma were seen in 8 (3.2%) and 5 (2.0%) patients, respectively. In 57 (23%), 64 (25.8%), and 87 (35.1%) patients, UC had invaded the subepithelial connective tissue, muscularis propria, and perivesical tissue, respectively. UC was multifocal in 53 patients (21.4%). The tumor was in the trigone and bladder neck in 160 patients (64.5%). Of the 248 patients, 98 (39.5%) had a history of recurrence. Stepwise discriminant analysis selected 3 variables of bladder UC (previous recurrence and location and number of foci) and correctly predicted the group in 72.2% of patients without and with UCP. Discriminant analysis selected 2 variables of bladder UC (focality and previous recurrence) and correctly predicted the group in 57.7% of patients without and with prostate adenocarcinoma. CONCLUSIONS Our approach can identify bladder UC variables that could guide urologists in the selection of the most appropriate surgical procedure.
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Affiliation(s)
- Roberta Mazzucchelli
- Polytechnic University of the Marche Region School of Medicine, United Hospitals, Ancona, Italy
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Abstract
Significant progress has been made in the standardization of bladder neoplasm classification and reporting. Accurate staging using the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) TNM system is essential for patient management, and has been reinforced by clinical evidence in recent years. It is now recognized that 'superficial' bladder carcinomas are a heterogenous group of tumors with diverse biological and clinical manifestations. The term 'superficial,' therefore, is no longer used for bladder tumor nomenclature. Recognition of diagnostic pitfalls associated with lamina propria invasion is critical for the evaluation of bladder tumor specimens. Neither the 1973 nor the 2004 WHO grading system appears to be useful for predicting the clinical outcome of invasive urothelial carcinoma. This review will discuss recent progress and controversial issues on the staging and substaging of bladder carcinomas. Essential elements for handling and reporting of bladder tumor specimens will also be discussed.
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Barbisan F, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Kirkali Z, Montironi R. Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int 2009; 103:1058-63. [DOI: 10.1111/j.1464-410x.2008.08207.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Autorino R, Di Lorenzo G, Damiano R, Giannarini G, De Sio M, Cheng L, Montironi R. Pathology of the prostate in radical cystectomy specimens: A critical review. Surg Oncol 2009; 18:73-84. [DOI: 10.1016/j.suronc.2008.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/20/2008] [Accepted: 07/14/2008] [Indexed: 11/27/2022]
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Lerner SP, Shen S. Pathologic assessment and clinical significance of prostatic involvement by transitional cell carcinoma and prostate cancer. Urol Oncol 2008; 26:481-5. [PMID: 18774459 DOI: 10.1016/j.urolonc.2008.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prostate is commonly involved by transitional cell carcinoma (TCC) in patients with bladder cancer. A number of clinicopathologic factors including multifocal carcinoma in situ, tumor location, and tumor stage are associated with prostatic TCC (pTCC). In addition, the manner and extent of pathologic examination also makes a significant difference in the detection rate. Distinct patterns and extent of pTCC have been described and are associated with pathologic stage of the primary bladder tumor as well as prognosis. Preoperative transurethral biopsy of the prostatic urethra is a sensitive and accurate method to detect pTCC and is helpful for surgical planning. Given the high incidence of pTCC and prostatic adenocarcinoma, radical cystoprostatectomy is the treatment of choice for loco-regional control for patients with T4a disease. Further studies are necessary to establish the role of neoadjuvant and adjuvant therapy for patient with prostatic stroma invasion.
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Affiliation(s)
- Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, and Department of Pathology, The Methodist Hospital, Houston, TX 77030, USA.
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Montironi R, Cheng L, Mazzucchelli R, Scarpelli M, Kirkali Z, Montorsi F, Lopez-Beltran A. Critical evaluation of the prostate from cystoprostatectomies for bladder cancer: insights from a complete sampling with the whole mount technique. Eur Urol 2008; 55:1305-9. [PMID: 18995951 DOI: 10.1016/j.eururo.2008.10.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
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Prostatic biology, histologic patterns and clinical consequences of transitional cell carcinoma. Curr Opin Urol 2008; 18:508-12. [DOI: 10.1097/mou.0b013e32830b86f9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pettus JA, Al-Ahmadie H, Barocas DA, Koppie TM, Herr H, Donat SM, Dalbagni G, Reuter VE, Olgac S, Bochner BH. Risk Assessment of Prostatic Pathology in Patients Undergoing Radical Cystoprostatectomy. Eur Urol 2008; 53:370-5. [PMID: 17689003 DOI: 10.1016/j.eururo.2007.07.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the incidence and location of prostate adenocarcinoma (PCa) and prostatic urothelial carcinoma (PUC) for patients undergoing radical cystoprostatectomy (RCP) for bladder cancer and to ascertain what preoperative information may be useful in predicting PUC or PCa in patients who may be candidates for prostate-sparing cystectomy. METHODS Between 2001 and 2004, 235 consecutive patients underwent RCP and had whole-mount sections of the prostate. We reviewed our prospective radical cystectomy database for preoperative clinicopathological information associated with each patient. The bladder and whole-mount prostate sections were re-reviewed to determine the location and depth of the bladder tumor as well as the presence of any associated PCa and PUC. RESULTS We identified 113 of 235 (48%) and 77 of 235 (33%) men with PCa and PUC, respectively. Among patients with PCa, 33 (29%) had Gleason score of > or = 7, 25 (22%) had PCa tumor volume > 0.5 cc, and 15 (13%) had extracapsular extension. On multivariable analysis, only increasing age was significantly associated with PCa (odds ratio=1.3, p=0.046). Of the 77 with PUC, 28 (36%) had in situ disease only, while 49 (64%) had prostatic stromal invasion. Bladder tumor location in the trigone/bladder neck (p<0.001) and bladder carcinoma in situ (p<0.001) was strongly associated with PUC in the final specimen. Overall, 158 (67%) had either PCa or PUC in the prostate. CONCLUSIONS PCa and/or PUC is present in a majority of RCP specimens. Current preoperative staging and tumor characteristics are not adequate for determining who can safely be selected for prostate-sparing cystectomy.
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Affiliation(s)
- Joseph A Pettus
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Shen SS, Lerner SP. Prostatic transitional cell carcinoma: pathologic features and clinical management. Expert Rev Anticancer Ther 2007; 7:1155-62. [PMID: 18028024 DOI: 10.1586/14737140.7.8.1155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostatic involvement by transitional cell carcinoma (pTCC) in patients with bladder cancer is a frequent finding, particularly in patients with high-grade invasive tumor and urothelial carcinoma in situ. Various patterns and levels of prostatic involvement have been described, and their impact in patients' management and their prognosis recognized. The role of prostatic urethral biopsy and intraoperative frozen section in the management of bladder cancer, tailoring to the bladder tumor stage is still not well defined and universally accepted. This review discusses the current understanding of the biology and histological patterns of pTCC and their clinical significance and management options. A rational approach for management of pTCC in patients with bladder cancer will be proposed on the basis of our experience and our review of literature.
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Affiliation(s)
- Steven S Shen
- Department of Pathology, The Methodist Hospital and Weill Medical College of Cornell University, 6565 Fannin Street, Houston, TX 77030, USA.
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Ayyathurai R, Gomez P, Luongo T, Soloway MS, Manoharan M. Prostatic involvement by urothelial carcinoma of the bladder: clinicopathological features and outcome after radical cystectomy. BJU Int 2007; 100:1021-5. [PMID: 17784885 DOI: 10.1111/j.1464-410x.2007.07171.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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Abstract
Improved survival following radical cystectomy for bladder cancer as a result of advancements in combination chemotherapy and surgical technique has resulted in a philosophical change in the surgeon's approach to urinary diversion selection. Aims have evolved from the mere diversion of urine to a functional bowel conduit such as an ileal conduit or ureterosigmoidostomy, to providing the optimal diversion for the patient's quality of life. While quality of life is important, one must also consider the stage of cancer and individual patient comorbidities. Which diversion provides the best local cancer control, the lowest potential for complications (short and long term), and the easiest emotional adjustment in lifestyle while still allowing the timely completion of chemotherapy and therapeutic goals? A multidisciplinary approach to diversion selection that includes the patient, the medical oncologist, radiation oncologist, internist, and surgeon is ideal. We describe the three most commonly used types of diversions today, including conduits, continent cutaneous reservoirs, and orthotopic urethral diversions, as well as issues relative to patient selection and functional outcomes in patients undergoing radical cystectomy for the treatment of bladder cancer.
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Affiliation(s)
- Dipen J Parekh
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Liedberg F, Chebil G, Månsson W. Urothelial carcinoma in the prostatic urethra and prostate: current controversies. Expert Rev Anticancer Ther 2007; 7:383-90. [PMID: 17338657 DOI: 10.1586/14737140.7.3.383] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We reviewed the literature on urothelial carcinoma in the prostatic urethra and prostate. We concluded that the incidence of urothelial carcinoma in the prostatic urethra and prostate is probably underestimated. This fact warrants thorough follow-up of patients with high-risk bladder cancers and also whole-mount examination of the prostate after cystectomy to recognize the true incidence and extent of such tumor involvement. Resectoscope loop biopsy is the method of choice to detect urothelial carcinoma in the prostatic urethra/prostate and such biopsies should include the area around the verumontanum to ensure optimal sensitivity. Carcinoma in situ in the prostatic urethra should be treated with intravesical Bacillus Calmette-Guérin and a transurethral resection of the prostate prior to that treatment might increase the contact of Bacillus Calmette-Guérin with the prostatic urethra, improve staging and in itself treat the prostatic involvement. Conservative treatment of carcinoma in situ in the prostatic ducts is an option, although radical surgery is probably best for treating extensive intraductal involvement, since data on the former strategy are inconclusive. Patients with stromal invasion should undergo radical surgery. It is necessary to take the route of prostatic involvement into account when estimating prognosis in each individual patient, since contiguous growth into the prostate is associated with worse prognosis. Prospective studies using a whole-mount technique to investigate the prostate are needed to clarify both the role of different routes of prostate invasion and the prognostic significance of different degrees of prostate invasion. At cystectomy, when urothelial carcinoma is present in the prostatic urethra and/or prostate, it is necessary to balance the risk of urethral recurrence and decreased sexual function against opinion and expectations expressed by the patient during preoperative counseling regarding urinary diversion and primary urethrectomy.
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Affiliation(s)
- Fredrik Liedberg
- Växjö County Hospital, Department of Surgery Section of Urology, 351 85 Växjö, Sweden.
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Palou J, Baniel J, Klotz L, Wood D, Cookson M, Lerner S, Horie S, Schoenberg M, Angulo J, Bassi P. Urothelial Carcinoma of the Prostate. Urology 2007; 69:50-61. [PMID: 17280908 DOI: 10.1016/j.urology.2006.05.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 04/05/2006] [Accepted: 05/03/2006] [Indexed: 10/23/2022]
Abstract
This study was conducted to explore the diagnosis and management of urothelial carcinoma of the prostate in superficial disease and carcinoma in situ, stromal invasion, primary urothelial carcinoma, and urethral recurrence after radical surgery. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) reviewed the diagnosis and management of urothelial carcinoma of the bladder. English-language literature about urothelial carcinoma of the prostate was identified and reviewed. Evidence-based recommendations for the diagnosis and management of urothelial carcinoma were made. Many recommendations were level 3 or 4 citations involving the diagnosis and management of superficial urothelial carcinoma; a few were level 2 citations. Level 1 citations related only to chemotherapy and radiotherapy in patients with stromal invasion, although these were not related specifically to invasive prostatic involvement. More than 130 reviewed citations are summarized in this review. Published reports on the diagnosis and treatment of superficial urothelial disease of the prostate primarily consist of short case series from individual centers. Prospective and multicenter trials are needed to identify the real incidence and the best management of these patients. In invasive disease of the prostate, the only large series were designed to investigate invasive bladder cancer.
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Affiliation(s)
- Juan Palou
- Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
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40
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Abstract
The 30-45% failure rate after radical cystoprostatectomy mandates that we explore and optimize multimodal therapy to achieve better disease control in these patients. Cisplatin-based multi-agent combination chemotherapy has been used with success in metastatic disease and has therefore also been introduced in patients with high-risk but non-metastatic bladder cancer. There is now convincing evidence that chemotherapy given pre-operatively can improve survival in these patients. In this review we establish the need for peri-operative chemotherapy in bladder cancer patients and summarize the evidence for the efficacy of neoadjuvant chemotherapy. The advantages and disadvantages of neoadjuvant versus adjuvant chemotherapy are discussed, and the main shortcomings of both--treatment-related toxicity and the inability to prospectively identify likely responders--are presented. Finally, a risk-adapted approach to neoadjuvant chemotherapy is presented, whereby the highest risk patients are offered treatment while those unlikely to benefit are spared the treatment-related toxicity.
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Affiliation(s)
- Peter C Black
- Department of Urology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1373, Houston, TX 77030, USA
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Huguet J, Crego M, Sabaté S, Salvador J, Palou J, Villavicencio H. Cystectomy in patients with high risk superficial bladder tumors who fail intravesical BCG therapy: pre-cystectomy prostate involvement as a prognostic factor. Eur Urol 2005; 48:53-9; discussion 59. [PMID: 15967252 DOI: 10.1016/j.eururo.2005.03.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 03/16/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE To review understaging and outcome of patients who underwent radical cystectomy (RC) for high risk superficial bladder cancer after bacillus Calmette-Guérin (BCG) failure. PATIENTS AND METHODS We carried out a retrospective study of 62 cases in which RC was indicated for clinical stage Tis, Ta, T1 transitional cell bladder tumors that failed transurethral resection (TUR) and BCG treatment. We used BCG (81 mg/Connaught BCG) in patients with superficial grade 3 tumors and CIS. We considered BCG failure a high-grade recurrence at 3 months of the first BCG course or after 2 courses. RC indications, correlation between their clinical and pathological stage and the ensuing progress were analyzed. We assessed the existence of any pre-cystectomy clinical or pathological factor related to understaging and survival. RESULTS RC was performed in 22 patients with carcinoma in situ (CIS) (35%), 7 with Ta (11,2%), 31 with T1 (50%), and 2 with Tx tumors (3%). All 62 but one were high-grade tumors (grade 3 and/or CIS). Tumor was clinically understaged with stages pT2 or greater on the RC specimen in 17 patients (27%). The presence of tumor in the prostatic urethra at the moment of endoscopic staging before RC was the only factor associated with clinical understaging (p=0.003) and shorter survival (p<0.0002). Five-year disease-specific survival rate was significantly lower in understaged (38%) as compared with not-understaged patients (90%) after a median follow-up of 40-months (range 1-142) (p=0.006). Overall five-year disease-specific survival was 79%. CONCLUSIONS RC should be performed prior to progression in high risk superficial tumors that fail after TUR and BCG. In patients with clinical and pathological nonmuscle invasive disease, RC provides an excellent disease-free survival. One third of patients with HRSBT who underwent RC after BCG failure were understaged and had a shorter survival. Tumor in the prostatic urethra at endoscopic staging was the only factor associated to understaging and shorter survival.
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Affiliation(s)
- J Huguet
- Urology Service, Fundació Puigvert, C/Cartagena, 340, 08025 Barcelona, Spain.
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Daneshmand S, Stein JP, Lesser T, Quek ML, Nichols PW, Miranda G, Cai J, Groshen S, Skinner EC, Skinner DG. PROGNOSIS OF SEMINAL VESICLE INVOLVEMENT BY TRANSITIONAL CELL CARCINOMA OF THE BLADDER. J Urol 2004; 172:81-4. [PMID: 15201742 DOI: 10.1097/01.ju.0000132131.64727.ff] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Transitional cell carcinoma (TCC) of the bladder that extends directly into contiguous organs (pT4) portends a poor prognosis. The 2002 American Joint Committee on Cancer staging system does not include seminal vesicle involvement by primary TCC of the bladder. In this analysis we evaluated the clinical outcomes and prognostic significance of seminal vesicle involvement with TCC of the bladder after radical cystectomy. MATERIALS AND METHODS From 1971 to 2001, 1,682 patients underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer. Only those tumors that involved adjacent organs through the bladder wall (pT4) were included. Overall 132 male patients with a median age of 68 years (range 36 to 98) qualified for analysis. Patients were stratified into 4 subgroups of 1) direct extravesical prostatic stromal involvement only in 37 patients (28%), 2) prostatic stroma and seminal vesicle involvement in 37 patients (28%), 3) seminal vesicle involvement only in 10 patients (8%) and 4) other contiguous pelvic organ involvement (stage pT4b) in 48 patients (36%). Overall 88 patients (67%) received some form of adjuvant therapy. At a median followup of 12.5 years (range 0 to 15.2) clinical outcomes were analyzed including overall and recurrence-free survival using Kaplan-Meier plots. RESULTS There was no significant difference in clinical outcomes or prognosis for groups 2 and 3, thus they were combined for analysis. Five-year overall survival for any seminal vesicle involvement (10%) was significantly worse than prostatic stromal involvement only (38%) but was similar to pT4b tumors (7%, p <0.0001). The 5-year recurrence-free survival for seminal vesicle involvement (14%) was also significantly worse than prostatic stromal involvement alone (68%) but similar to that pT4b disease (25%, p = 0.01). Results were controlled for lymph node status. CONCLUSIONS Patients with extravesical tumor extension into seminal vesicles and contiguous pelvic organs are at high risk for recurrence and progression. Involvement of the seminal vesicles by direct extension of bladder TCC portends a prognosis similar to that of pT4b disease and should, therefore, be classified as such.
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Affiliation(s)
- Siamak Daneshmand
- Department of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California 90089, USA.
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Liedberg F, Chebil G, Månsson W. Hematogenous dissemination of transitional cell carcinoma in the bladder to the prostate. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2004; 37:359-60. [PMID: 12944198 DOI: 10.1080/00365590310014797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a case of hematogenous dissemination of transitional cell carcinoma in the bladder to the prostate in a 36-year-old male in whom cystoprostatectomy was performed and an orthotopic bladder substitute constructed.
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44
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Abstract
While it is now clear that chemotherapy can contribute to improved outcome for some patients with muscle invasive bladder cancer, selection criteria for this very heterogeneous disease are lacking. The authors make an appeal for a biologically (in contrast to anatomically) based staging system, and urge that perioperative chemotherapy be given with standard combinations with curative intent.
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Affiliation(s)
- Randall Millikan
- Department of Genitourinary Medical Oncology, Genitourinary Center, University of Texas, M.D. Anderson Cancer Center, Houston, TX 77033, USA.
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45
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Abstract
Superficial bladder cancer comprises the majority of bladder tumors presenting today. Although the word "superficial" connotes a benign behaving curable disease, it is clear from long-term observations of the natural history of the disease that there are two discrete entities of superficial bladder cancer, one a low-grade innocuous tumor and the other a high-grade potentially lethal tumor. These two entities vary in their histologic appearance, risk of tumor recurrence, pattern of recurrence, and risk of tumor progression. Although work on prognostic markers is promising, currently none are sufficiently reliable; therefore, clinical factors are used to identify patients with a higher risk of tumor recurrence or progression. These include the tumor stage, tumor grade, number of tumors (multifocality), presence of associated carcinoma in situ, and initial response to therapy. Surveillance schedules are individualized based on the risks for recurrence and progression. High-risk patients who undergo successful treatment of their bladder tumor initially recur more commonly in the bladder, but have a progressive risk over time of extravesical recurrences necessitating lifelong surveillance of the bladder, urethra, prostate, and upper tracts. Patients who are refractory to conservative management with intravesical therapy and TUR should be apprised of the risks for further conservative treatment and consider early radical cystectomy in an attempt to improve long-term survival. The advent and long-term success of orthotopic continent diversions has made the decision for early radical cystectomy more palatable to both the patient and physician.
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Affiliation(s)
- S Machele Donat
- Department of Urology, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, 1275 York Avenue, New York, NY 10021, USA.
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Volkmer BG, Küfer R, Maier S, Bartsch G, Bach D, Hautmann R, Gschwend JE. Outcome in patients with seminal vesicle invasion after radical cystectomy. J Urol 2003; 169:1299-302. [PMID: 12629347 DOI: 10.1097/01.ju.0000057248.09720.e7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the impact of seminal vesicle invasion by transitional cell carcinoma of the bladder in a large cystectomy series. MATERIALS AND METHODS Between January 1985 and February 2002, 1,125 cystectomies were performed at our 2 institutions. In 68 male patients there was pathologically proved tumor extension to the perivesical fat, prostatic stroma and/or seminal vesicles, including group 1: 38 to the prostatic stroma alone, group 2-12 to the seminal vesicles alone, and group 3-18 to the seminal vesicles and prostatic stroma. Complete followup was available for all patients. Overall disease specific and progression-free survival rates were calculated using the Kaplan-Maier-Method. Survival rates were compared using the log rank test. RESULTS The overall 5-year survival rate for all 68 patients was 23.1%. The 5-year disease specific survival rates were 41.1%, 0% and 0%, and the 5-year progression-free survival rates were 32.1%, 0% and 0% for groups 1 to 3, respectively. Survival was significantly decreased in patients with seminal vesicle infiltration with or without prostatic stromal infiltration compared with prostatic involvement alone. This difference was independent of lymph node status in groups 1 versus 2 and 3. CONCLUSIONS Seminal vesicle invasion by bladder carcinoma has a significant impact on disease specific and progression-free survival compared with prostatic stromal involvement alone.
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Affiliation(s)
- Björn G Volkmer
- Department of Urology, Faculty of Medicine, University of Ulm, Germany
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47
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Transitional Cell Carcinoma Involving The Prostate: A Clinicopathological Retrospective Study Of 76 Cases. J Urol 2003. [DOI: 10.1097/00005392-200301000-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Njinou Ngninkeu B, Lorge F, Moulin P, Jamart J, Van Cangh PJ. Transitional cell carcinoma involving the prostate: a clinicopathological retrospective study of 76 cases. J Urol 2003; 169:149-52. [PMID: 12478124 DOI: 10.1016/s0022-5347(05)64056-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We reviewed the degree to which extension from transitional cell carcinoma into the prostate affects survival. We also compared whether prostatic stromal invasion occurring via direct extension through the bladder wall differs from stromal invasion arising intraurethrally. MATERIALS AND METHODS A total of 76 men who underwent radical cystectomy for transitional cell carcinoma also had prostate involvement. Patients were separated into group 1-18 with primary bladder tumor extending transmurally through the bladder wall to invade the prostate and group 2-58 with prostate involvement arising from within the prostatic urethra. In the latter group the degree of prostate invasion was classified as urethral mucosal involvement, ductal/acinar involvement and stromal invasion. RESULTS The 5-year overall survival and recurrence-free rate were 22% and 28% in group 1 versus 43% and 45% in group 2, respectively. In group 2 survival rates were similar in those with prostatic urethral and ductal tumors (without stromal invasion). Five-year overall survival rates without and with stromal invasion were 49% and 25%, respectively (p = 0.024). Prostate involvement decreased survival, which varied according to primary bladder stages (Pis, P1, P2a/b and P3a/b, p = 0.004) or superficial (Pis, Pa and P1) and muscle invasive (P2a/b and P3/b, p = 0.045), disease in 2 groups. Those with positive lymph nodes experienced poorer outcomes in each group. The 5-year overall survival rate in the 19 men with positive lymph nodes was 13% and it was 44% with negative lymph nodes (p = 0.034). The major prognostic factors were age, degree of prostate invasion and lymph node involvement. CONCLUSIONS The invasion pathways of prostate invasion in patients with transitional cell bladder carcinoma have a statistically significant prognostic role in survival. Transitional cell carcinoma of the bladder extending into the prostate through the bladder wall and bladder carcinoma that did not directly infiltrate the prostate through the bladder wall are 2 distinct clinicopathological entities that should not be included in the same staging grade.
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Affiliation(s)
- B Njinou Ngninkeu
- Division of Urology, Department of Pathology, Cliniques Universitaires Mont-Godinne and Saint-Luc, Université Catholique de Louvain, Yvoir, Belgium
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49
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Affiliation(s)
- Harry W Herr
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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50
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Nixon RG, Chang SS, Lafleur BJ, Smith JA JA, Cookson MS. Carcinoma in situ and tumor multifocality predict the risk of prostatic urethral involvement at radical cystectomy in men with transitional cell carcinoma of the bladder. J Urol 2002; 167:502-5. [PMID: 11792906 DOI: 10.1097/00005392-200202000-00012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Determining which patients are at risk for prostatic urethral involvement of urothelial carcinoma may alter assessment of the prostatic urethra before radical cystectomy and ultimately influence the choice of urinary diversion. We determined risk factors predictive of prostatic urethral involvement using preoperative bladder tumor characteristics in male patients who underwent radical cystoprostatectomy due to urothelial carcinoma of the bladder. MATERIALS AND METHODS We reviewed 192 consecutive radical cystectomy specimens from men with transitional cell carcinoma from June 1995 to June 2000. The prostatic urethra in each specimen was analyzed and urethral involvement was characterized as carcinoma in situ, intraductal invasion or prostatic stromal invasion. We then examined which clinical bladder tumor characteristics correlated with the incidence and extent of prostatic urethral involvement by performing multiple variable analysis. RESULTS Prostatic urethral involvement was evident in 30 of the 192 patients (15.6%). Of the 80 patients with carcinoma in situ in the bladder 25 (31.3%) had concomitant prostatic urethral involvement with carcinoma, whereas only 5 (4.5%) of the 112 with no evidence of carcinoma in situ had prostatic urethral involvement. Likewise 25 of the 72 patients (34.7%) with multifocal tumors had concomitant prostatic urethral involvement with carcinoma, whereas only 5 (4.2%) of the 120 with no evidence of multifocality had prostatic urethral involvement. In the multiple variable logistic regression model the odds of prostatic urethral involvement were 12 and 15-fold greater when carcinoma in situ and tumor multifocality were present, respectively. CONCLUSIONS Carcinoma in situ and/or tumor multifocality are valuable prognostic indicators of prostatic urethral involvement. However, in their absence prostatic urethral involvement was rare. Ultimately the extent of prostatic urethral involvement may influence decisions, such as the choice of urinary diversion and need for urethrectomy, in men undergoing radical cystectomy.
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Affiliation(s)
- Randy G Nixon
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2765, USA
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