Prostatic biology, histologic patterns and clinical consequences of transitional cell carcinoma

Abstract

Prostatic involvement with TCC in patients with bladder cancer is a common event. In patients with recurrent high-grade nonmuscle invasive cancer and patients undergoing radical cystoprostatectomy, a thorough assessment of the prostatic urethra and stroma is imperative for accurate staging and treatment planning.

Urothelial carcinoma of the bladder with transmural and direct prostatic stromal invasion: does extent of stromal invasion significantly impact patient outcome?

“…UCa with prostatic involvement is not an uncommon finding in radical cystoprostatectomy specimens for bladder cancer, with an incidence ranging from 12% to 48% [2][3][4]6,7,9,10,12,13]. However, primary UCa of the prostate is a rare neoplasm with an incidence ranging from 1% and 5% of all primary prostatic carcinomas [8,14].…”

“…Previous studies have described various patterns and mechanisms of prostatic involvement: UCa in situ of the prostatic urethra, colonization of prostatic ducts/acini, invasion of prostatic urethral subepithelial connective tissue, prostatic stromal invasion from the latter, and direct transmural invasion through the bladder wall, with variable data on prognostic implications [3][4][5][6][7][8][9]. Most experts are in agreement that there is a difference in outcome between patients with UCa in situ of the prostatic urethra or UCa in situ with colonization of prostatic ducts/acini and patients with prostatic stromal invasion.…”

“…Schellhammer et al were the first to demonstrate that prostatic stromal invasion significantly impacted patient survival [2]. Subsequent studies have investigated the various mechanisms of prostatic stromal invasion, including direct transmural extension from the bladder, invasion from the prostatic urethra, and invasion from colonized prostatic ducts and acini [3][4][5][6][7][8][9]. Most studies suggest that the former carries a worse prognosis than the latter.…”

Management of the Prostate and Urethra in Patients Undergoing Radical Cystectomy

“…Several theories have been presented to explain the pathogenesis of prostatic urothelial cell carcinoma. Since the prostatic urethra and large ducts are lined by transitional epithelium, it could develop in a synchronous manner at the time that a primary bladder lesion develops [13]. Alternatively, the prostate can be involved by direct extension of a bladder lesion posteriorly or directly through the bladder neck [14].…”

Australian & New Zealand Faculty of Radiation Oncology Genito‐Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder

“…Prostatic urothelial carcinoma is seen in 20–43% of cystoprostatectomy specimens 41,42,70–72 . The method of spread to the prostate is thought to be either transmural invasion or in situ spread in an intra‐epithelial fashion 41,73 . This is a topic of increasing interest in the surgical literature, as prostate‐sparing techniques are being studied, 42 but it is difficult to predict extension to the prostatic urethra prior to RT.…”