title: Outcomes of patients undergoing radical cystoprostatectomy for bladder cancer with prostatic involvement on final pathology.
abstract: OBJECTIVE
  To evaluate the impact of prostatic urothelial carcinoma (PUC) on survival of patients with bladder cancer undergoing radical cystoprostatectomy (RCP).
  
  
  METHODS
  From 1998 to 2005, 463 consecutive RCPs were performed for UC of the bladder. Patients with PUC at final pathology were grouped by route of prostatic invasion (bladder origin or prostatic urethral origin) and by depth of invasion (carcinoma in situ, ductal invasion, and stromal invasion). Univariate and multivariate survival analyses were performed.
  
  
  RESULTS
  In all, 35% (162/463) of patients had PUC. The 3-year overall survival (OS) was 58.2% for patients who did not have PUC, 59.2%, 51.7%, and 16.8% in order of increasing depth of prostatic invasion for patients with PUC of urethral origin, and 6.7% for patients with bladder-origin PUC. Survival differed significantly between stromal and non-stromal PUC (P < 0.001). Patients with PUC of bladder origin had a higher rate of positive lymph nodes (LNs) than patients with stromal PUC of prostate origin (74.3% vs 27.8%, P < 0.001), but survival was similar (P = 0.619). On multivariate analysis, age (P = 0.035), increasing bladder stage (P = 0.003), stromal invasion (P = 0.002) and positive LNs (P < 0.001) were predictors of poor OS.
  
  
  CONCLUSIONS
  Depth of prostatic invasion correlates with outcome. While prostatic involvement originating in the bladder is associated with higher rates of positive LNs, survival is similar to patients with stromal involvement of urethral origin. Age, bladder tumour stage, prostatic stromal involvement and positive LNs predict adverse outcome. Our data support separate staging of the prostate in RCP specimens.
authors.affiliation: Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN 37232-5770, USA. dan.barocas@vanderbilt.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*