IS STAGE PT4A (D1) RELIABLE IN ASSESSING TRANSITIONAL-CELL CARCINOMA INVOLVEMENT OF THE PROSTATE IN PATIENTS WITH A CONCURRENT BLADDER-CANCER - A NECESSARY DISTINCTION FOR CONTIGUOUS OR NONCONTIGUOUS INVOLVEMENT

Purpose: A series of patients with concurrent transitional cell carcin oma involvement of the prostate and bladder is reviewed to define the impact of prostate involvement pathways and the degree of prostate inv asion on survival rate. Materials and Methods: A total of 72 patients who underwent radical cystectomy for pathological stage pT4a (D1) canc er was divided into contiguous-stage pT4a, transitional cell carcinoma of the bladder extended into the prostate through the bladder wall an d noncontiguous-stage pT4a simultaneous transitional cell carcinoma of the prostate and bladder carcinoma that did not directly infiltrate i nto the prostate through the bladder wall. In the latter group the deg ree of prostate invasion was classified as urethral mucosal involvemen t, ductal/acinar involvement, stromal invasion and extracapsular exten sion. The survival rate was estimated by the Kaplan-Meier and Cox prop ortional hazards methods. Comparisons between curves were performed by univariate log rank and multivariate L-ratio tests. Results: The over all 5-year survival rate for stage pT4a was 21.5% (median followup 64 months). Furthermore, 46% and 7% of patients in noncontiguous and cont iguous pT4a groups, respectively, were estimated to be alive (p <0.000 ). Those with positive nodes experienced a poor outcome in both groups . Of patients with noncontiguous pT4a stage 100% with urethral mucosal involvement, 50% with ductal/acinar involvement and 40% with stromal invasion were estimated to be alive. The major prognostic factors were bladder tumor stage, nodal involvement and degree of prostate invasio n. Conclusions: The invasion pathways of the prostate in patients with transitional cell bladder carcinoma have a statistically significant prognostic role. Contiguous and noncontiguous involvements are 2 disti nct clinicopathological features and they should not be included in th e same stage. In the noncontiguous stage pT4a group bladder and prosta te transitional cell carcinoma should be separately staged, and prosta te involvement also should be staged according to invasion degree.