Impact of the level of urothelial carcinoma involvement of the prostate on survival after radical cystectomy

Objective: Urothelial prostatic involvement (UPI) at the time of radical cystoprostatectomy (RCP) was found associated with worse survival outcomes by several previous reports. Our aim is to evaluate the impact of different levels of UPI on survival outcomes using a large series of male patients treated with RCP. Methods: Whole step section specimens from 995 male BCa patients were assessed for UPI defined as: no involvement vs. prostatic urethral carcinoma in situ (CIS) vs. lamina propria involvement vs. ductal CIS vs. prostate stromal involvement. Primary end point of the study was predictors of prostatic involvement at RCP and its impact on overall survival after surgery. Results: Prostatic involvement was recorded in 307 (30.9) patients: 28 with prostatic urethral CIS, 12 with lamina propria involvement, 13 with ductal CIS and 47 with stromal involvement. Median follow-up was 70 months. Patients with stromal involvement had a worse 5-year survival (12) than those with prostatic urethra CIS (40), lamina propria involvement (36), and ductal CIS (35). Considering predictors of prostatic involvement, multifocal tumor (Odds Ratio [OR]: 6.60, p<0.001), lymphovascular invasion (OR: 2.61, p<0.001), lymph node metastases (OR: 2.02, p<0.001) and CIS (OR: 2.02, p<0.001) were found associated. Similar predictors were found assessing stromal involvement. Conclusions: Approximately one third of RCP patients harbor prostatic involvement of urothelial carcinoma. While all UPI are associated with worse overall survival, stromal involvement confers the worst outcome supporting its classification as T4 in the TNM staging.