World Journal of Urology

, Volume 37, Issue 12, pp 2683–2689 | Cite as

Prognostic implications of prostatic urethral involvement in non-muscle-invasive bladder cancer

  • Aaron BrantEmail author
  • Marcus Daniels
  • Meera R. Chappidi
  • Gregory A. Joice
  • Nikolai A. Sopko
  • Andres Matoso
  • Trinity J. Bivalacqua
  • Max Kates
Original Article



Non-muscle-invasive bladder cancer involving the prostatic urethra is associated with pathologic upstaging and shorter survival. We investigated the survival impact of prostatic urethral involvement in non-muscle-invasive patients who are not upstaged at cystectomy.


From 2000 to 2016, 177 male patients underwent cystectomy for high-risk non-muscle-invasive bladder cancer and remained pT1, pTis, or pTa, and N0 on final pathology; 63 (35.6%) patients had prostatic urethral involvement and 114 (64.4%) did not. Prostatic involvement was non-invasive (Ta or Tis) in 56 (88.9%) patients and superficially invasive (T1) in 7 (11.1%) patients. No patient had stromal invasion. Log-rank and Cox regression analyses were used to evaluate survival.


Compared to patients without prostatic urethral involvement, patients with involvement were more likely to have received intravesical therapy (84.6% vs. 64.4%, p < 0.01), have multifocal tumor (90.8% vs. 51.7%, p < 0.01), and have positive urethral margins (7.7% vs. 0%, p < 0.01) and ureteral margins (18.5% vs. 5.1%, p < 0.01). Log-rank comparison showed inferior recurrence-free, cancer-specific, and overall survival in patients with prostatic involvement (p = 0.01, p = 0.03, p < 0.01). Patients with prostatic urethral involvement were more likely to experience recurrence in the urinary tract (p < 0.01). On Cox regression, prostatic urethral involvement was an independent predictor of overall mortality (HR = 2.08, p < 0.01).


Prostatic urethral involvement is associated with inferior survival in patients who undergo cystectomy for non-muscle-invasive bladder cancer and remain pT1, pTis, or pTa on final pathology. Prostatic urethral involvement is thus an adverse pathologic feature independent of its association with upstaging.


Bladder cancer Non-muscle-invasive Prostatic urethra Radical cystectomy 


Author contributions

AB: project development, data collection, data analysis and manuscript writing/editing; MD: data collection and manuscript writing/editing; MC: data collection and manuscript writing/editing; GJ: data collection and manuscript writing/editing; NS: data collection and manuscript writing/editing; AM: data collection and manuscript writing/editing; TB: project development and manuscript writing/editing; MK: project development, data analysis and manuscript writing/editing.


This study was funded by the Greenberg Bladder Cancer Institute.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30CrossRefGoogle Scholar
  2. 2.
    Chang SS, Boorjian SA, Chou R et al (2016) Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO Guideline. J Urol 196:1021–1029CrossRefGoogle Scholar
  3. 3.
    Herr HW (1998) Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol 16:1099–1102CrossRefGoogle Scholar
  4. 4.
    Lightfoot AJ, Rosevear HM, Nepple KG et al (2012) Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high-grade non-muscle invasive bladder cancer. Int J Urol 19:988–993CrossRefGoogle Scholar
  5. 5.
    Huguet J, Crego M, Sabate S et al (2005) Cystectomy in patients with high risk superficial bladder tumors who fail intravesical BCG therapy: pre-cystectomy prostate involvement as a prognostic factor. Eur Urol 48:53–59CrossRefGoogle Scholar
  6. 6.
    Palou J, Sylvester RJ, Faba OR et al (2012) Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette–Guerin. Eur Urol 62:118–125CrossRefGoogle Scholar
  7. 7.
    Solsona E, Iborra I, Ricos JV et al (1995) The prostate involvement as prognostic factor in patients with superficial bladder tumors. J Urol 154:1710–1713 (discussion 59) CrossRefGoogle Scholar
  8. 8.
    Herr H, Solgani P (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166:1296–1299CrossRefGoogle Scholar
  9. 9.
    Palou J, Wood D, Bochner BH et al (2013) ICUD-EAU International Consultation on Bladder Cancer 2012: urothelial carcinoma of the prostate. Eur Urol 63:81–87CrossRefGoogle Scholar
  10. 10.
    Rikken CH, van Helsdingen PJ, Kazzaz BA (1987) Are biopsies from the prostatic urethra useful in patients with superficial bladder carcinoma? Br J Urol 59:145–147CrossRefGoogle Scholar
  11. 11.
    von Rundstedt FC, Lerner SP, Godoy G et al (2015) Usefulness of transurethral biopsy for staging the prostatic urethra before radical cystectomy. J Urol 193:58–63CrossRefGoogle Scholar
  12. 12.
    Liedberg F, Anderson H, Blackberg M et al (2007) Prospective study of transitional cell carcinoma in the prostatic urethra and prostate in the cystoprostatectomy specimen Incidence, characteristics and preoperative detection. Scand J Urol Nephrol 41:290–296CrossRefGoogle Scholar
  13. 13.
    Kates M, Ball MW, Chappidi MR et al (2016) Accuracy of urethral frozen section during radical cystectomy for bladder cancer. Urol Oncol 34:532.e1–532.e6CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Aaron Brant
    • 1
    • 3
    Email author
  • Marcus Daniels
    • 1
  • Meera R. Chappidi
    • 1
  • Gregory A. Joice
    • 1
  • Nikolai A. Sopko
    • 1
  • Andres Matoso
    • 2
  • Trinity J. Bivalacqua
    • 1
  • Max Kates
    • 1
  1. 1.James Buchanan Brady Urological Institute, Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of PathologyJohns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.James Buchanan Brady Foundation Department of UrologyWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations