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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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Bladder cancer Non-muscle-invasive Prostatic urethra Radical cystectomy 

Notes

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.

Funding

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.

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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

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