(UroToday.com) The 2024 South Central AUA annual meeting included a session on bladder cancer, featuring a presentation by Dr. Amanda Myers discussing urothelial carcinoma of the prostate and intravesical therapy. High-grade prostatic urethral involvement in patients with non-muscle invasive bladder cancer (NMIBC) is classified as high-risk according to the AUA guidelines, although the best treatment approach is not well-established. Limited evidence exists for bladder-sparing treatments in these patients. At the 2024 South Central AUA annual meeting, Dr. Myers and colleagues reported results on the outcomes of patients with high-grade prostatic urethral involvement treated with bladder-sparing options.
This study included a review of consecutive patients diagnosed with NMIBC between January 2005 and May 2023 to identify patients with urothelial carcinoma of the prostate. Since the goal was to report on outcomes of patients who received bladder-sparing intravesical therapy as primary treatment, Dr. Myers and colleagues excluded patients with BCG-unresponsive tumors (n = 10) and those undergoing upfront radical cystectomy (n = 10):
The primary outcome was high-grade disease-free survival, defined as patients alive without high-grade disease in the prostate or bladder. TheKaplan-Meierr method was used to estimate disease-free survival, cystectomy rate, progression free survival, and overall survival.
The study included 42 patients with high-grade urothelial carcinoma of the prostate (papillary only: 11, mucosal CIS: 14, CIS involving ducts and acini: 17). Repeat transurethral resection was performed in 31 (74%) cases prior to intravesical therapy. Concurrent NMIBC was present in 35 patients. Forty patients received BCG and two patients received intravesical chemotherapy:
At the 3-month assessment, 29 patients (69%) were disease-free and 90% of patients received ongoing maintenance treatment. Despite this, 30 (71%) patients recurred at a median of 8.5 months (IQR 6.7 to 12.6). High grade disease free survival is as follows, favoring papillary only disease:
There were 17 (40%) patients that had a cystectomy at a median of 10.3 months (IQR 5.5-14.2). Progression to muscle-invasive or metastatic free survival at 1 year was 85% (95% CI 72-92):
Several limitations of this study include the results reflect selected patients receiving care at a singlehigh-volumee center, and the investigators were unable to discern any association of concurrent bladder NMIBC to outcomes.
Dr. Myers concluded her presentation discussing urothelial carcinoma of the prostate and intravesical therapy with the following take-home points:
- Patients with high-grade urothelial carcinoma of the prostate treated with intravesical therapy have high rates of recurrence and progression within the first year of treatment
- Vigilant follow-up is mandatory if bladder-sparing treatment is pursued, as there is limited time to assess effectiveness of intravesical therapy for these patients
Presented by: Amanda Myers, MD, The University of Texas MD Anderson Cancer Center, Houston, TX
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 South Central American Urological Association (AUA) Annual Meeting, Colorado Springs, CO, Wed, Oct 30 – Sat, Nov 2, 2024.