[Risk factors for prostatic involvement with transitional cell carcinoma in radical cystectomy specimens]

ABSTRACT

Bladder cancer is the most common malignancy of the urinary tract. At the initial diagnosis of bladder cancer, approximately 30% of cases are diagnosed as muscle-invasive disease. About one third of cases that diagnosed initially as non-muscle-invasive disease progress to muscle-invasive, radical cystectomy [RC] is considered the standard treatment for these tumors. In fact, in a significant number of cases the transitional cell carcinoma [TCC] of the bladder infiltrates into prostatic tissue, in addition to the chance for the presence of occult prostatic adenocarcinoma. This study was performed to ascertain which variables of bladder cancer might be useful in predicting of involvement the prostate in radical cystectomy specimens. This approach can help in identifying bladder cancer variables that could guide urologists in the selection of patients who may be candidates for prostatesparing cystectomy [PSC]. We retrospectively reviewed the results of 150 patients treated by RC for advanced bladder cancer. We documented the variables of these tumors and its pathological results in regard of infiltration to the prostatic urethra and to the prostate. The cancer was present in the prostatic urethra in 15 patients [10%] and in the prostate in 39 patients [26%], altogether in 54 patients [36%]. Infiltration was found in 38 patients from 65 with history of recurrence [58.46%]. In primary tumors, only 18.82% [16 of 85 patients] were infiltrated. Infiltration was found in 35 patients from 72 with multifocal tumor [48.6%]. The infiltration rate was 66.66% in tumors located in bladder neck and trigon [14 from 21 patients]. Infiltration was again very prominent in carcinoma in-situ [CIS] [75%] and in high grade cancer [38.7%]. In addition 12 cases [8%] of primary adenocarcinoma of prostate were identified. Our study can help in identifying bladder cancer variables that could guide urologists in the selection of most appropriate surgical procedure, especially in regard to prostate-sparing cystectomy. It is not advisable to perform PSC when the tumors are of high grade, recurrent or progressive, multiple, located in the trigon and bladder neck, or presence of CIS