title: Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Knoedler
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.forename: Prabin
authors.initials: P
authors.lastname: Thapa
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tarrell
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000556:secondary; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology* / Q000601:surgery
keywords: bladder cancer; cystectomy; invasion; prostate; urethra; urothelial carcinoma