ONCOLOGIC OUTCOMES OF BLADDER-SPARING MANAGEMENT FOR HIGH-GRADE NON-INVASIVE UROTHELIAL CARCINOMA OF THE PROSTATIC URETHRA

Alexander C. Martin; Ian M. McElree; Sarah L. Mott; Jordan R. Richards; Reid A. Stubbee; Ryan L. Steinberg; Michael A. O'Donnell; Vignesh T. Packiam

doi:10.1016/j.urolonc.2024.01.144

Among patients with high-grade (HG) non-muscle invasive urothelial carcinoma (UC) of the bladder, prostatic urethral involvement occurs in 16-39%. Management of prostatic urethral UC is dependent on depth of invasion, with radical cystoprostatectomy being the standard recommendation for disease invasive to the prostatic stroma. While there is no clear consensus on the management of non-invasive prostatic urethral UC, many patients are similarly recommended radical management. Recent reports have demonstrated reasonable outcomes with endoscopic bladder-sparing approaches but are limited by small sample size. Our institution has utilized intravesical therapy for the management of non-invasive prostatic urethral UC. Herein, we describe oncologic outcomes of a cohort of patients with HG non-invasive prostatic urethral UC managed with bladder-sparing approaches at a single institution. We retrospectively identified patients with HG non-invasive UC in the prostatic urethra from 2005-2021. Patients were included if they elected initial bladder sparing management with;at least one post-treatment endoscopic evaluation. Patients were excluded if they did not undergo induction intravesical therapy. After identification, TURP was performed in 35% to facilitate entry of subsequent agents. Intravesical therapies utilized included BCG, sequential intravesical gemcitabine and docetaxel (Gem/Doce), and other single or multi-agent chemotherapies. Induction treatments were scheduled once weekly for 6 weeks. The primary endpoint was HG recurrence-free survival (HG-RFS) following induction. Secondary endpoints included cystectomy-free survival (CFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Recurrence was defined as any pathologically confirmed UC of the prostate or bladder. Progression was defined as increase in T stage or development of muscle-invasive or metastatic disease. Endpoints were calculated using the Kaplan-Meier method, indexed from the start of intravesical treatment. We identified 62 patients with prostatic urethral UC. Median follow-up was 38 months (IQR 19-74). Forty-seven (76%) and 9 (15%) patients had history of/concomitant bladder or upper tract UC, respectively. Thirty-six (58%) patients received prior intravesical therapy. Pathology at time of prostatic urethral UC diagnosis was CIS in 52 (84%), HGTa in 9 (14%), and HGT1 in 1 (2%).;Subsequent induction regimens were BCG (44%), Gem/Doce (42%), and other chemotherapies (14%). HG-RFS was 45%, 43%, and 38% at 1, 2, and 3 years, respectively (Figure 1). Seventeen patients (27%) underwent cystectomy at median of 12 months, of whom 5 (8%) had ≥T2 and 3 (5%) had N+ disease. CFS, PFS, CSS, and OS were 65% (Figure 2), 69%, 92% and 83% at 3 years, respectively. On Cox regression analysis, there were no clinicopathologic or treatment characteristics associated with HG-RFS or PFS. In a high-risk cohort, non-invasive prostatic urethral UC can be effectively treated with intravesical therapy in some patients. While the majority of patients were able to avoid cystectomy, careful patient selection is needed given the inherent risk of disease progression. There were no apparent predictive factors of treatment response. Further study and prospective evaluation are warranted.

ONCOLOGIC OUTCOMES OF BLADDER-SPARING MANAGEMENT FOR HIGH-GRADE NON-INVASIVE UROTHELIAL CARCINOMA OF THE PROSTATIC URETHRA

View Online

Abstract

Details

Metrics