Prostatic urothelial carcinoma: is transurethral prostatectomy necessary before bacillus Calmette‐Guérin immunotherapy?

Abstract

urinary cytology. Also, the outcome of previous series using similar methodology was compared with the outcome of studies in which TURP was not performed. RESULTSIn all, 20 patients with PUC were treated with TURP followed by intravesical instillations of BCG. The median follow-up was 52.5 months. All patients had an initial complete response (CR). The prostatic urethra 5-year recurrence-free survival rate was 90%. However, bladder and prostatic urethra 5-year recurrence-free survival rate was only 30%. Five patients (25%) died from urothelial carcinoma (UC) after a median period of 58.5 months (two from bladder cancer metastases and three from upper tract metastases). The long-term prostatic urethra CR rate in studies using TURP before immunotherapy was significantly higher than the CR rate in studies using immunotherapy alone ( P < 0.001). However, there was no difference when bladder and prostatic urethra CR rates were considered together ( P = 0.54). CONCLUSIONIn patients with PUC, TURP before BCG immunotherapy eliminates PUC in most cases, and is probably the preferred treatment for this disease. The risk of UCspecific mortality in these patients is high. KEYWORDSprostatic urothelial carcinoma, transurethral prostatectomy, bacillus Calmete-Gúerin immunotherapy Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo evaluate the efficacy of transurethral prostatectomy (TURP) followed by bacillus Calmette-Guérin (BCG) immunotherapy in patients with prostatic urothelial carcinoma (PUC) and compare the results of studies using combined TURP and BCG with studies in which TURP was not performed. PATIENTS AND METHODSPatients with bladder cancer and PUC were treated with TURP followed by six weekly intravesical instillations of BCG. Response was determined and monitored by periodic bladder and prostatic urethra biopsies and

Current Disease Management of Primary Urethral Carcinoma

“…A combined approach of TUR and bacillus Calmètte-Guerin (BCG) therapy in patients with noninvasive disease can suffice to assure satisfactory outcomes with complete response rates of up to 75% and 5-yr RFS rates of 90% [55][56][57]. This is also recommended by the current guidelines and is in line with the findings of Gofrit et al [58], who reported a better response rate of patients treated with TUR of the bladder B and BCG compared with BCG therapy only [22 23]. A thorough follow-up with cystoscopy and urine cytology is important to identify recurrences early, which are often best treated with radical RCU with or without perioperative CHT [55][56][57].…”

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

“…137 There is very limited evidence to guide recommendations for patients with ductal involvement; current evidence consists of small series of fewer than 10 patients each. [138][139][140] While TUR biopsies of the prostatic urethra can provide information to complement staging and support clinical decision-making prior to radical cystoprostatectomy, it does lack sensitivity and specificity and should not be considered mandatory.…”

Revisiting an Old Conundrum: A Systematic Review and Meta-Analysis of Intravesical Therapy for Treatment of Urothelial Carcinoma of the Prostate

“…The method of sampling was not standardized, with only one study reliably performing resectoscope loop biopsies of the verumontanum and lateral lobes in a routine manner [ 14 ]. The rate of 3.4%was found in a study obtaining routine biopsies in high risk patients (however type of biopsy was not specified [ 15 ]), while the higher estimate of 27.8%was from a study performing cold cup biopsies in all patients with bladder CIS only [ 10 ]. This is comparable to results from RC specimens [ 22 ], and support routine PU biopsies in patients with bladder CIS at a minimum.…”