Bladder-sparing management for high grade noninvasive urothelial carcinoma of the prostate

Alexander C Martin; Ian M McElree; Sarah L Mott; Helen Y Hougen; Ryan L Steinberg; Michael A O'Donnell; Vignesh T Packiam

doi:10.1016/j.urolonc.2025.04.007

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Bladder-sparing management for high grade noninvasive urothelial carcinoma of the prostate

Journal article

Open access

Peer reviewed

Bladder-sparing management for high grade noninvasive urothelial carcinoma of the prostate

Alexander C Martin, Ian M McElree, Sarah L Mott, Helen Y Hougen, Ryan L Steinberg, Michael A O'Donnell and Vignesh T Packiam

Urologic oncology, Vol.43(9), pp.521.e1-521.e8

09/2025

DOI: 10.1016/j.urolonc.2025.04.007

PMCID: PMC13218301

PMID: 40414744

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Abstract

To characterize the oncologic outcomes in patients with high-grade noninvasive urothelial carcinoma of the prostate (NMIUC-P) treated with intravesical therapy and assess for clinicopathologic features associated with response. Patients with high-grade NMIUC-P treated with intravesical Bacillus Calmette-Guerin (BCG) or chemotherapy between 2005 and 2021 were retrospectively analyzed. Survival probabilities were estimated using the Kaplan-Meier method. Cox regression was used to evaluate the effect of clinicopathologic and treatment characteristics on high-grade recurrence-free survival (HG-RFS) and progression-free survival (PFS). A total of 62 patients with median follow-up of 38 months (IQR 19-74) were included. NMIUC-P pathology was carcinoma in situ containing in 52 (84%), high-grade Ta in 9 (14%), and high-grade T1 in 1 (2%). Fifty (80%) patients had concomitant bladder UC. Induction regimens were BCG (44%), gemcitabine/docetaxel (42%), and other chemotherapies (14%). HG-RFS was 45%, 43%, and 38% at 1, 2, and 3 years, respectively. Seventeen patients (27%) underwent cystectomy at a median of 12 months, of whom 5 (29%) had ≥T2 and 3 (18%) had N+ disease. Among all patients, PFS was 87%, 69%, and 69% at 1, 2, and 3 years, respectively. Cystectomy-free, cancer-specific, and overall survival were 65%, 92%, and 83% at 3 years, respectively. No clinicopathologic or treatment characteristics were significantly associated with HG-RFS. In a high-risk cohort of patients with NMIUC-P, a select number of patients were able to avoid cystectomy and remain recurrence-free at 3-years after pursuing bladder-sparing intravesical treatment. However, given the high incidence of disease progression, careful patient selection is critical. Further prospective studies are needed to identify markers of response.

Bladder Cancer

Prostatic urethral

Gemcitabine

BCG

Docetaxel

Details

Title: Subtitle: Bladder-sparing management for high grade noninvasive urothelial carcinoma of the prostate
Creators: Alexander C Martin - University of Iowa
Ian M McElree - University of Iowa
Sarah L Mott - University of Iowa
Helen Y Hougen - University of Iowa
Ryan L Steinberg - University of Iowa
Michael A O'Donnell - University of Iowa
Vignesh T Packiam - Rutgers, The State University of New Jersey
Resource Type: Journal article
Publication Details: Urologic oncology, Vol.43(9), pp.521.e1-521.e8
DOI: 10.1016/j.urolonc.2025.04.007
PMID: 40414744
PMCID: PMC13218301
NLM abbreviation: Urol Oncol
ISSN: 1078-1439
eISSN: 1873-2496
Publisher: ELSEVIER SCIENCE INC
Grant note: John & Carol Walter Family Foundation
This work was supported in part by the John & Carol Walter Family Foundation. Medical writing assistance was provided by Vaishali Kulkarni, Ph.D., Medical Writer, Rutgers Cancer Institute of New Jersey.
Language: English
Electronic publication date: 05/24/2025
Date published: 09/2025
Academic Unit: Urology
Record Identifier: 9984825538202771

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