Validation of New AJCC Exclusion Criteria for Subepithelial Prostatic Stromal Invasion from pT4a Bladder Urothelial Carcinoma

Patel, Amit R.; Cohn, Joshua A.; Latif, Muhammad M. M. Abdel; Miocinovic, Ranko; Steinberg, Gary D.; Paner, Gladell P.; Hansel, Donna E.

doi:10.1016/j.juro.2012.09.006

Cited by 27 publications

(20 citation statements)

References 19 publications

(30 reference statements)

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“…The present findings are similar to the results from Patel et al [19], who evaluated the updated AJCC staging classification and noted a difference in 5-year CSS survival for patients with extravesical prostatic invasion vs subepithelial prostatic invasion. Nevertheless, that series included a short follow-up and evaluated a relatively smaller cohort.…”

Section: Discussionsupporting

confidence: 92%

“…Prior studies have reported conflicting data about the prognostic significance of the mode and depth of prostatic invasion of UC for patient outcomes after RC [4, [12][13][14]17,19,20]. That is, Barocas et al [13], in 162 patients with prostatic involvement from UC, reported a significantly worse survival for patients with prostate stromal involvement than non-stromal prostatic urethral involvement (P < 0.001), but no difference in survival among patients with stromal involvement arising within the bladder or prostate (P = 0.62).…”

Section: Discussionmentioning

confidence: 99%

“…While a recent multi‐institutional series evaluated the prognostic significance of the new staging classification , the study included relatively few patients (97 patients), and had a median postoperative follow‐up of only 12.8 months. Moreover, the study assessed the survival difference between tumours with transmural invasion of the prostate vs subepithelial invasion, the investigators did not address whether the depth of prostatic urethral invasion (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the study assessed the survival difference between tumours with transmural invasion of the prostate vs subepithelial invasion, the investigators did not address whether the depth of prostatic urethral invasion (i.e. pTis vs pT2 prostate tumours) was independently associated with survival . In addition, the independent significance of a coexisting extravesical bladder tumour among patients with prostatic urethral involvement of UC according to the updated staging system similarly remains to be established.…”

Section: Introductionmentioning

confidence: 99%

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Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy

et al. 2014

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Objective• To evaluate survival among patients with urothelial carcinoma (UC) within the prostate in order to assess the impact of depth of tumour invasion as well as the importance of a concurrent bladder tumour. Patients and Methods• We identified 201 patients who underwent radical cystectomy (RC) between 1980 and 2006 and were found to have UC involving the prostate.• All specimens were re-reviewed by a genitourinary pathologist.• Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Cox hazard regression models tested the association of clinicopathological variables with outcome. Results• In all, 93 patients had pTis disease in the prostate, 43 had pT2 tumours, and 66 patients were pT4a. The median follow-up was 10.5 years.• The 5-year cancer-specific survival for patients with pTis, pT2, and pT4a prostate UC was 73%, 57%, and 21% respectively (P < 0.001).• On multivariable analysis, higher prostate tumour stage (hazard ratio [HR] 2.09; P = 0.01), positive lymph node status (HR 2.09; P = 0.002), and concurrent ≥pT3 bladder cancer (HR 4.16; P < 0.001) were significantly associated with an increased risk of death from UC. Conclusions• Among patients with prostatic UC involvement, depth of tumour invasion was significantly associated with cancer-specific mortality, validating the staging reclassification.• Concurrent locally advanced bladder cancer also negatively impacted survival, suggesting the potential prognostic value of reporting a secondary tumour stage in such cases.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy

et al. 2014

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“…Specifically, we confirmed results previously described by May et al [13], describing SVI as a poor prognostic factor in pT4a patients affected by prostate involvement. Differential impact of prostatic involvement has been previously described where prostatic stromal invasion is associated with worse survival outcomes compared to prostatic involvement by carcinoma in situ or lamina propria invasion of the prostatic urethra [22,23]. On the contrary, no data regarding differential prostatic invasion were reported in our database.…”

Section: Discussionmentioning

confidence: 63%

Radical Cystectomy in Pathological T4a and T4b Bladder Cancer Patients: Is There Any Space for Sub Stratification?

Moschini¹,

Zamboni²,

Mattei³

et al. 2019

Urol Int

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Introduction: According to TNM staging, pathological T4ab are comprehensive of the invasion of prostate, seminal vesicles, uterus or vagina and pelvic or abdominal wall. However, few data are available on the perioperative and oncological outcomes of specific organ invasion. Materials and Methods: A total of 917 consecutive bladder cancer (BCa) patients treated with radical cystectomy (RC) at a single institution between 1990 and 2015 were studies. Cox regression analyses were used to stratify pT4ab according to the site of invasion and survival. Results: Overall, 176 (19.2%) and 40 (4.4%) patients harbored pT4a or pT4b disease. Specifically, 84 (9.2%) patients reported prostate and/or SVI invasion, 62 (6.8%) prostate only, 16 (1.7%) uterus, 14 (1.5%) vaginal, 24 (2.6%) pelvic wall, and 16 (1.7%) abdominal wall invasion. The median follow-up in pT4 patients was 48 months. The 1-year cancer-specific mortality (CSM) rates were 71, 65, 24, 50, 50, and 72%, for vaginal, uterus, prostate only, prostate and/or seminal vesicles, pelvic wall, and abdominal wall invasions, respectively. At multivariable Cox regression, the invasion of prostate only (hazard ratio [HR] 3.53), prostate and/or SVI (HR 4.98), uterus (HR 7.16), vagina (HR 6.12), pelvic (HR 11.81), abdominal (8.36) were associated with adverse CSM. Conclusions: Our study described the differences in survival related to invasion site in pT4 patients, confirming poor survival expectancies in this subgroup. Patients with prostate invasion only seem to be associated with better survival than those affected by concomitant invasion of seminal vesicles. Uterus and vaginal invasions were associated with poor survival outcomes. Patients Summary: In this study, we looked at the outcome of locally advanced invasive BCa (stage pT4) in patients treated with RC at a tertiary referral hospital. We analyzed the differences in survival related to the specific organ invasion. We confirmed poor survival in this subgroup of patients. Only patients who had prostate invasion only seem to have a better survival.

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Uncommon Cancers of the Prostate

Tagawa

Batra

Robinson

et al. 2017

Textbook of Uncommon Cancer

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Validation of New AJCC Exclusion Criteria for Subepithelial Prostatic Stromal Invasion from pT4a Bladder Urothelial Carcinoma

Abstract: Subepithelial prostatic stromal invasion from urothelial carcinoma has more favorable outcomes compared to transmural pT4a disease. Our results support the exclusion of subepithelial prostatic stromal invasion from the pT4a bladder urothelial carcinoma staging class.

Cited by 27 publications

References 19 publications

Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy

Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy

Radical Cystectomy in Pathological T4a and T4b Bladder Cancer Patients: Is There Any Space for Sub Stratification?

Uncommon Cancers of the Prostate

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