Introduction

The impact of the different types of prostate involvement by urothelial carcinoma (PUC) or prostate adenocarcinoma (PCa) at the time of radical cystoprostatectomy (RCP) has not been fully investigated.

Methods

Data from 893 male patients treated with RCP and pelvic lymph node dissection at a tertiary referral center for nonmetastatic bladder cancer between 1992 and 2012 were assessed. Significant PCa was defined as extracapsular disease and/or Gleason Score ? 7. Prostatic urothelial carcinoma (PUC) was stratified as stromal versus urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental PCa and PUC on outcomes.

Results

PCa was present in 319 (35.7%) patients, of which 45 (14.1%) had significant disease. While, the proportion of significant PCa did not change significantly (p=0.8), the rate of indolent PCa increased from 17.1%, to 29.4% to 37.9%, respectively (p<0.001). PUC was identify in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with disease recurrence and cancer-specific mortality. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (Hazard Ratio [HR]:2.01, p=0.03) cancer-specific mortality (HR: 1.65, p=0.01) and overall mortality (HR: 1.45, p=0.03).

Conclusions

PCa involvement does not affect outcomes in patients treated with RCP for bladder cancer. Conversely, prostatic stromal invasion with urothelial carcinoma confers a poor survival confirming its aggressiveness.

Funding

none