Urothelial carcinoma in the prostatic urethra and prostate: current controversies

Abstract

We reviewed the literature on urothelial carcinoma in the prostatic urethra and prostate. We concluded that the incidence of urothelial carcinoma in the prostatic urethra and prostate is probably underestimated. This fact warrants thorough follow-up of patients with high-risk bladder cancers and also whole-mount examination of the prostate after cystectomy to recognize the true incidence and extent of such tumor involvement. Resectoscope loop biopsy is the method of choice to detect urothelial carcinoma in the prostatic urethra/prostate and such biopsies should include the area around the verumontanum to ensure optimal sensitivity. Carcinoma in situ in the prostatic urethra should be treated with intravesical Bacillus Calmette-Guérin and a transurethral resection of the prostate prior to that treatment might increase the contact of Bacillus Calmette-Guérin with the prostatic urethra, improve staging and in itself treat the prostatic involvement. Conservative treatment of carcinoma in situ in the prostatic ducts is an option, although radical surgery is probably best for treating extensive intraductal involvement, since data on the former strategy are inconclusive. Patients with stromal invasion should undergo radical surgery. It is necessary to take the route of prostatic involvement into account when estimating prognosis in each individual patient, since contiguous growth into the prostate is associated with worse prognosis. Prospective studies using a whole-mount technique to investigate the prostate are needed to clarify both the role of different routes of prostate invasion and the prognostic significance of different degrees of prostate invasion. At cystectomy, when urothelial carcinoma is present in the prostatic urethra and/or prostate, it is necessary to balance the risk of urethral recurrence and decreased sexual function against opinion and expectations expressed by the patient during preoperative counseling regarding urinary diversion and primary urethrectomy.

Comparisons of Quality of Life and Functional and Oncological Outcomes after Orthotopic Neobladder Reconstruction: Prostate-Sparing Cystectomy versus Conventional Radical Cystoprostatectomy

“…Some studies described invasive urothelial carcinoma or adenocarcinoma in the prostate specimens being found after radical cystoprostatectomy so that prostate-sparing surgery might not be performed in some circumstances [11, 12]. Yang et al even reported up to 53% incidental prostatic adenocarcinoma or urothelial carcinoma invasions in Chinese patients undergoing radical cystoprostatectomy [13].…”

Challenges in the pathological reporting of urothelial carcinoma involving prostatic transurethral resection specimens within a single institution

“…[2][3][4][5][6][7][8][9][10][11][12][13] Previously described challenges in the reporting of bladder cancer include evaluating muscularis propria invasion, soft tissue margins, lymphovascular invasion, and lymph node status. [2][3][4][5][6][7][8][9][10][11][12][13] Previously described challenges in the reporting of bladder cancer include evaluating muscularis propria invasion, soft tissue margins, lymphovascular invasion, and lymph node status.…”

“…1 The published incidence of concomitant UC of the bladder and prostate or prostatic urethra in cystectomy series ranges from 10% to 48%. 2,14,15 In regards to treatment, the extent of prostatic involvement impacts the various modalities offered to patients. 2,14,15 In regards to treatment, the extent of prostatic involvement impacts the various modalities offered to patients.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13] While various authors endorse loop or transurethral resection (TUR) of the prostate prior to radical cystoprostatectomy (CP), there are no widely accepted guidelines defining which patients should be selected to undergo these procedures. 2,14 A system for clearly defining prostatic involvement and accurate staging is potentially beneficial to clinical outcome. Generally, conservative management using intravesical Bacillus Calmette-Guerin with/without prior TUR is indicated for carcinoma in situ of the prostatic ducts and urethra, while radical CP is suggested for extensive intraductal involvement or fibromuscular stroma invasion.…”

Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage

“…Extension of UC in the PU is certainly underestimated [8], although it has significant prognostic importance. Direct extension of UC into the prostate has the worst prognosis as is reflected by the WHO 2004 classification, which stages these tumors as pT4.…”