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de Angelis M, Siech C, Di Bello F, Peñaranda NR, Goyal JA, Tian Z, Longo N, Chun FKH, Puliatti S, Saad F, Shariat SF, Longoni M, Gandaglia G, Moschini M, Montorsi F, Briganti A, Karakiewicz PI. Incidence, Characteristics and Survival Rates of Bladder Cancer after Rectosigmoid Cancer Radiation. Cancers (Basel) 2024; 16:2404. [PMID: 39001466 PMCID: PMC11240771 DOI: 10.3390/cancers16132404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Historical external beam radiation therapy (EBRT) for rectosigmoid cancer (RCa) predisposed patients to an increased risk of secondary bladder cancer (BCa). However, no contemporary radiotherapy studies are available. We addressed this knowledge gap. MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results database (2000-2020), we identified non-metastatic RCa patients who either underwent radiotherapy (EBRT+) or did not (EBRT-). Cumulative incidence plots and multivariable competing risk regression models (CRR) were fitted to address rates of BCa after RCa. In the subgroup of BCa patients, the same methodology addressed BCa-specific mortality (BCSM) according to EBRT exposure status. RESULTS Of the 188,658 non-metastatic RCa patients, 54,562 (29%) were EBRT+ vs. 134,096 (73%) who were EBRT-. In the cumulative incidence plots, the ten-year BCa rates were 0.7% in EBRT+ vs. 0.7% in EBRT- patients (p = 0.8). In the CRR, EBRT+ status was unrelated to BCa rates (multivariable HR: 1.1, p = 0.8). In the subgroup of 1416 patients with BCa after RCa, 443 (31%) were EBRT+ vs. 973 (69%) who were EBRT-. In the cumulative incidence plots, the ten-year BCSM rates were 10.6% in EBRT+ vs. 12.1% in EBRT- patients (p = 0.7). In the CRR, EBRT+ status was unrelated to subsequent BCSM rates (multivariable HR: 0.9, p = 0.9). CONCLUSION Although historical EBRT for RCa predisposed patients to higher BCa rates, contemporary EBRT for RCa is not associated with increased subsequent BCa risk. Moreover, in patients with BCa after RCa, exposure to EBRT does not affect BCSM.
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Affiliation(s)
- Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy;
| | - Natali Rodriguez Peñaranda
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Jordan A. Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy;
| | - Felix K. H. Chun
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Mattia Longoni
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giorgio Gandaglia
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (M.L.); (G.G.); (M.M.); (F.M.); (A.B.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (M.d.A.); (C.S.); (F.D.B.); (N.R.P.); (J.A.G.); (Z.T.); (F.S.)
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Durant AM, Lee YS, Mi L, Faraj K, Lyon TD, Singh P, Tyson II MD. Effect of Bacille Calmette-Guérin for Non-Muscle-Invasive Bladder Cancer After Prostate Radiotherapy. Bladder Cancer 2024; 10:35-45. [PMID: 38993532 PMCID: PMC11181702 DOI: 10.3233/blc-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND Little is known about the impact of prior prostate radiation therapy (RT) on the Bacille Calmette-Guerin (BCG) immunotherapy response in patients with non-muscle invasive bladder cancer (NMIBC). OBJECTIVE We hypothesized that the damaging radiation effects on the bladder could negatively influence BCG efficacy. METHODS Men with a history of high-risk NMIBC were identified within the Surveillance, Epidemiology, and End Results-Medicare database. All patients completed adequate BCG defined as at least 5 plus 2 treatments completed within 12 months. Patients were stratified into 2 groups: with prior RT for prostate cancer and without prior RT before the diagnosis of NMIBC. The primary endpoint was a 5-year composite for progression defined as disease progression requiring systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, or cancer-specific death. RESULTS We identified 3,466 patients with NMIBC, including 145 with prior RT for prostate cancer. Five-year progression occurred in 471 patients (13.6%). Patients with prior RT were older than patients without prior RT (77.0 vs 75.0 years; P < .001). The distribution of T stage was significantly different at diagnosis between the RT and non-RT groups (RT: Ta, 44.8%; Tis, 18.6%; T1, 36.6%; without RT: Ta, 40.9%; Tis, 10.8%; T1, 48.3%; P = .002). No difference in the risk of total progression was observed between patients with and without prior RT (P = .67). Similarly, no difference was observed after multivariable adjustment (hazard ratio, 0.99; 95% CI, 0.61-1.58; P = .95). CONCLUSION For patients with NMIBC who undergo adequate BCG treatment, prior RT for prostate cancer was not associated with worse 5-year progression-free survival.
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Affiliation(s)
| | - Yeonsoo S. Lee
- Mayo Clinic Alix School of Medicine – Florida campus, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Lanyu Mi
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Kassem Faraj
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Parminder Singh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
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Chin CP, Smith WH, Cesaretti J, Terk M, Garden EB, Araya JS, Palese MA, Stock RG, Buckstein M. Clinical and treatment characteristics of secondary bladder malignancies following low dose rate brachytherapy for prostate cancer. Urol Oncol 2022:S1078-1439(22)00491-4. [PMID: 36588020 DOI: 10.1016/j.urolonc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE/OBJECTIVES To characterize the clinical course and prognosis of bladder malignancies associated with prior prostate brachytherapy SUBJECTS/PATIENTS AND METHODS: We queried our institutional database for patients with bladder cancer (BC) diagnosed between January 2005 and April 2019 who had previously undergone low dose rate (LDR) prostate brachytherapy. Patients diagnosed with BC at least 1 year following LDR prostate brachytherapy with or without external beam radiation therapy were included. Clinical and disease-specific characteristics were abstracted from chart review and survival outcomes were estimated using Kaplan-Meier estimates. We compared the pathologic characteristics and prognosis of secondary BCs in our study cohort to those of BCs diagnosed after prostate cancer managed without radiation reported by the Surveillance, Epidemiology, and End Results (SEER) populational database from 2005 to 2018. RESULTS Three hundred seventy-five patients were identified with combined diagnosis of prostate cancer and BC, 51 of whom met inclusion criteria in the study cohort. Median times from brachytherapy to BC diagnosis for the study and SEER cohort were 9.5 ± 4.5 and 6.3 ± 4.1 years, respectively. Compared to the SEER cohort, significantly greater proportion of BC from the study cohort presented with high-grade (study: 78.4%, SEER: 52.3%, P = 0.0008) and with MIBC (Study BC 35.3%, SEER BC: 17.5%, P = 0.0009). The study and the SEER cohort had similar 5-year overall survival (study: 67.9%, SEER: 58.0%, P = 0.1099), and 5-year cancer-specific survival (study: 81.0%, SEER: 82.8%, P = 0.5559). The 5-year progression-free survival for the study cohort was 43.7% (95% CI: 28.8-57.7). CONCLUSION Compared to bladder cancers following prostate cancer managed without radiation, bladder malignancies following prostate LDR brachytherapy present with higher grade and are more likely to be muscle invasive. Despite the aggressive presenting features of postprostate brachytherapy BC, there were no differences in overall and cancer-specific survival between the groups.
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Affiliation(s)
- Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William H Smith
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jamie Cesaretti
- Terk Oncology, Division of Florida Physician Specialists, Jacksonville, Florida
| | - Mitchell Terk
- Terk Oncology, Division of Florida Physician Specialists, Jacksonville, Florida
| | - Evan B Garden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Sewell Araya
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Richard G Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Durant AM, Chang YH, Faraj KS, Tyson MD. BCG Administration after Prior Radiation Treatment for Prostate Cancer. Clin Genitourin Cancer 2022; 20:591-597. [PMID: 35798647 DOI: 10.1016/j.clgc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Prostate radiotherapy is associated with worse oncologic outcomes in patients with bladder cancer. The underlying mechanism is incompletely understood but is thought to be related to an altered microenvironment promoting tumorigenesis. However, there is a gap in the literature regarding how the effect of BCG varies according to prior radiotherapy in patients with non-muscle invasive bladder cancer (NMIBC). In this context, we sought to evaluate oncologic outcomes in NMIBC patients who have previously undergone prostate radiotherapy compared to patients with no prior history of pelvic radiotherapy. METHODS This is a retrospective cohort study that includes all patients who received intravesical for NMIBC at our institution from 2001 to 2019. Patients were stratified into 3 cohorts: prior radiotherapy (RT), radical prostatectomy (RP), and no prostate cancer (No PCa). The outcomes of interest were recurrence at 1-year, progression to muscle-invasive bladder cancer (MIBC), and progression to metastatic disease. Comparisons were also made between cohorts with respect to elapsed time from radiation therapy. Wilcoxon rank-sum test was used for comparing continuous variables, while χ2 and Fischer's exact tests were used to examine categorical variables. RESULTS In 199 total patients who underwent BCG for NMIBC, 23 had a prior history of prostate radiotherapy treatment, while 17 underwent prior radical prostatectomy. Overall, 41.2% of patients had recurrence at 1 year. There was no difference in the number of induction or maintenance BCG administrations received between the cohorts within the first year. There was no significant difference in recurrence at 1 year between the 3 cohorts (P = .56). There was also no difference in progression to MIBC or progression to metastatic disease with P = .50 and 0.89, respectively. CONCLUSION The risk of recurrence after induction BCG treatment for high-grade NMIBC does not vary according to prior radiation treatment for prostate cancer.
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Affiliation(s)
- Adri M Durant
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
| | - Yu-Hui Chang
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, AZ
| | | | - Mark D Tyson
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
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Scherñuk J, González MI, Vecchio F, Alfieri AG, Tobia IP, Tejerizo JC, Favre GA. Clinical and histopathological features of bladder cancer following radiotherapy for prostate cancer: A comparative study. Urol Oncol 2022; 40:492.e1-492.e6. [DOI: 10.1016/j.urolonc.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
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Effect of prior radiation on stage, differentiation, and survival in bladder cancer. World J Urol 2022; 40:719-725. [PMID: 34988649 DOI: 10.1007/s00345-021-03901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Clinically significant differences in radiation-related bladder tumors are not well-characterized, and survival analyses are needed. In this study, we aimed to utilize a national cancer database to evaluate the effect of prior radiation on tumor characteristics and survival in bladder cancer patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) 9 database was queried to identify patients diagnosed with bladder cancer as a second malignancy. Patients having undergone radiation prior to developing bladder cancer were selected for comparative analysis. Logistic regression was used to generate odds ratios to evaluate differences in differentiation, stage, grade, and tumor size. Kaplan-Meier analysis and Cox non-proportional hazards regression models were used to assess the association between previous radiation and bladder cancer survival. RESULTS A total of 25,408 patients were identified, of which 14,570 patients had sufficient data for analysis. Of these, 5968 (41.0%) received radiation for their primary malignancy. Prior radiation conferred a lower risk of developing moderately- or poorly-differentiated bladder tumors and muscle invasive or node-positive disease. An increased risk of squamous cell carcinoma was noted (OR 1.43, CI 1.06-1.93). Prior radiation led to an increased risk of bladder cancer-specific (HR 1.13, CI 1.03-1.24) mortality at 5 years. The greatest effect of prior radiation was an increased risk of bladder cancer-specific mortality for carcinoma in situ at 5 years (OR 2.37, CI 1.45-3.86). CONCLUSION Prior radiation is associated with lower grade and stage of bladder tumors in addition to worse cancer-specific survival.
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Genomic Features of Muscle-invasive Bladder Cancer Arising After Prostate Radiotherapy. Eur Urol 2021; 81:466-473. [PMID: 34953602 PMCID: PMC9018481 DOI: 10.1016/j.eururo.2021.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/12/2021] [Accepted: 12/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Muscle-invasive bladder cancer (MIBC) is a rare but serious event following definitive radiation for prostate cancer. Radiation-associated MIBC (RA-MIBC) can be difficult to manage given the challenges of delivering definitive therapy to a previously irradiated pelvis. The genomic landscape of RA-MIBC and whether it is distinct from non-RA-MIBC are unknown. OBJECTIVE To define mutational features of RA-MIBC and compare the genomic landscape of RA-MIBC with that of non-RA-MIBC. DESIGN, SETTING, AND PARTICIPANTS We identified patients from our institution who received radiotherapy for prostate cancer and subsequently developed MIBC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed whole exome sequencing of bladder tumors from RA-MIBC patients. Tumor genetic alterations including mutations, copy number alterations, and mutational signatures were identified and were compared with genetic features of non-RA-MIBC. We used the Kaplan-Meier method to estimate recurrence-free (RFS) and overall (OS) survival. RESULTS AND LIMITATIONS We identified 19 RA-MIBC patients with available tumor tissue (n = 22 tumors) and clinical data. The median age was 76 yr, and the median time from prostate cancer radiation to RA-MIBC was 12 yr. The median RFS was 14.5 mo and the median OS was 22.0 mo. Compared with a cohort of non-RA-MIBC analyzed in parallel, there was no difference in tumor mutational burden, but RA-MIBCs had a significantly increased number of short insertions and deletions (indels) consistent with previous radiation exposure. We identified mutation signatures characteristic of APOBEC-mediated mutagenesis, aging, and homologous recombination deficiency. The frequency of mutations in many known bladder cancer genes, including TP53, KDM6A, and RB1, as well as copy number alterations such as CDKN2A loss was similar in RA-MIBC and non-RA-MIBC. CONCLUSIONS We identified unique mutational properties that likely contribute to the distinct biological and clinical features of RA-MIBC. PATIENT SUMMARY Bladder cancer is a rare but serious diagnosis following radiation for prostate cancer. We characterized genetic features of bladder tumors arising after prostate radiotherapy, and identify similarities with and differences from bladder tumors from patients without previous radiation.
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Murthy PB, Lone Z, Corrigan D, Campbell R, Munoz-Lopez C, Caveney M, Gerber D, Ericson KJ, Thomas L, Zhang JH, Kaouk J, Weight C, Berglund R, Haber GP, Lee BH. Survival outcomes following radical cystectomy in patients with prior pelvic radiation for prostate cancer: A matched cohort analysis. Urol Oncol 2021; 40:10.e13-10.e19. [PMID: 34400070 DOI: 10.1016/j.urolonc.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the impact of prior pelvic radiation therapy (XRT) on outcomes following radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS We performed a retrospective review comparing patients with bladder cancer requiring RC and prior history of XRT for prostate cancer to those undergoing RC without XRT history at our institution from 2011-2018. Propensity score matching was performed with the following variables: age, chronic kidney disease, nutritional deficiency, neoadjuvant chemotherapy use, Charlson comorbidity index, surgical approach, urinary diversion type, and pathologic T-stage. Perioperative, pathologic and oncologic outcomes were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Categorical variables were assessed utilizing the Pearson Chi Square Test, and continuous variables with the Wilcoxon rank-sum test. The Kaplan-Meier method with stratified-log rank was used to compare survival outcomes. Multivariable Cox proportional hazards models were utilized to identify predictors of overall and recurrence free survival. RESULTS 227 patients were included, of which 47 had radiotherapy for prostate cancer. 47% of patients in the radiation cohort received external beam radiation therapy, 47% received brachytherapy and 7% received both. There were no differences in recurrence-free survival (P = 0.82) or overall survival (P = 0.25). Statistically significant differences in perioperative or postoperative outcomes such as 90-day complication, readmission, mortality rates, or ureteroenteric anastomotic stricture rates were not found. Rates of node-positive disease, median lymph node yield, positive surgical margin rates, lymphovascular invasion, or variant histology were not significantly different between cohorts. CONCLUSIONS After matching for T-stage and other clinical variables, history of pelvic XRT for prostate cancer in patients who later required RC for bladder cancer, was not associated with an increased rate of perioperative complications or an independent predictor of RFS or OS.
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Affiliation(s)
- Prithvi B Murthy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Dillon Corrigan
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH
| | - Rebecca Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Maxx Caveney
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Gerber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Kyle J Ericson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Lewis Thomas
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Byron H Lee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Patel NH, Miranda G, Cai J, Desai M, Gill I, Aron M. Robotic Radical Cystectomy Outcomes after Intervention for Prostate Cancer. J Endourol 2021; 35:633-638. [PMID: 33267670 DOI: 10.1089/end.2020.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: We evaluated patients who underwent treatment for prostate cancer and then subsequent robot-assisted radical cystectomy (RARC). Our objective was to understand clinical, pathologic, and survival outcomes in these patients. Materials and Methods: A total of 333 male patients underwent RARC with standard intracorporeal urinary diversion from 2009 to 2019. We evaluated patients who underwent a radical prostatectomy (RP) and either external beam radiation or brachytherapy (XRT) before RARC. These patients were compared with patients who underwent RARC without any prior intervention for or history of prostate cancer (radical cystectomy [RC]). Results: Patients in the RP and XRT groups were found to be older than the RC group (p = 0.0108) and also have a greater Charlson comorbidity index (p < 0.001). There was no difference in estimated blood loss, operative time, and length of stay across all three groups. The RP group had a higher rate of positive margins 31.58% compared with RC and XRT at 8.22% and 10.00%, respectively (p = 0.0036). There was also a higher rate of extravesical disease on final pathology report for the XRT group at 60.00% compared with 37.5% and 36.85% for RC and RP, respectively (p = 0.0056). Overall survival was lowest in the XRT group compared with RP and RC (p > 0.001) with no difference in recurrence-free survival. Conclusion: Patients in the RP group have higher rates of positive margin, whereas patients in the XRT group have higher rates of extravesical disease and overall survival after undergoing a RARC. Careful counseling and attention to these parameters is required in these patient populations.
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Affiliation(s)
- Neel H Patel
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Gus Miranda
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Jie Cai
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Mihir Desai
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Inderbill Gill
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Monish Aron
- Department of Urology, University of Southern California, Los Angeles, California, USA
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Sha ST, Dee EC, Mossanen M, Mahal BA, Zaslowe-Dude C, Royce TJ, Hirsch MS, Sonpavde G, Preston MA, Nguyen PL, Mouw KW, Muralidhar V. Clinical characterization of radiation-associated muscle-invasive bladder cancer. Urology 2021; 154:208-214. [PMID: 33857569 DOI: 10.1016/j.urology.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC. METHODS We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database and stratified patients based on whether radiation had been administered to a prior pelvic primary cancer. We used Fine-Gray competing risks regression to compare adjusted bladder cancer-specific mortality (BCSM) for RA-MIBC compared to primary MIBC. RESULTS There were 1,093 patients with RA-MIBC and 58,997 patients with primary MIBC. RA-MIBCs were more likely to be T4 at diagnosis (21.0% vs 17.3%, P < .001), and less likely to be node-positive (10.3% vs 17.1%, P < .001). The rate of 5-year BCSM was significantly higher for patients with RA-MIBC vs primary MIBC (56.1% vs 35.3%, AHR 1.24, P < .001), even after stratification by other tumor, treatment and patient-specific factors. CONCLUSION RA-MIBCs tended to present with higher grade and T stage disease and were less likely to receive curative treatment. Even when accounting for stage, grade, and receipt of treatment, patients with RA-MIBC had worse survival compared to those with primary MIBC. These findings suggest that RA-MIBC present unique clinical challenges and may also represent a biologically more aggressive disease compared to primary MIBC. Future research is needed to better understand the biology of RA-MIBC and develop improved treatment approaches.
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Affiliation(s)
- Sybil T Sha
- Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Mossanen
- Department of Surgery, Division of Urology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Cierra Zaslowe-Dude
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Trevor J Royce
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Guru Sonpavde
- Department of Medicine, Section of Medical Oncology, Baylor College of Medicine, Houston, TX
| | - Mark A Preston
- Department of Urology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Kubota Y, Hatakeyama S, Hashimoto T, Fujita N, Okamoto T, Suzuki Y, Yamamoto H, Imai A, Yoneyama T, Hashimoto Y, Koie T, Ohyama C. Robot-assisted radical cystectomy in a patient with muscle-invasive bladder cancer following radiotherapy for prostate cancer. IJU Case Rep 2019; 2:236-239. [PMID: 32743424 PMCID: PMC7292197 DOI: 10.1002/iju5.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Muscle-invasive bladder cancer following radiotherapy for prostate cancer is rare. We reported a case of muscle-invasive bladder cancer who underwent robot-assisted radical cystectomy following radiotherapy for prostate cancer. CASE PRESENTATION A 72-year-old man was referred to our division with a muscle-invasive bladder cancer. He had a history of intensity-modulated radiation therapy for localized prostate cancer. After three courses of platinum-based neoadjuvant chemotherapy, he obtained a radiologic complete response. He elected for robot-assisted radical cystectomy, standard lymph node dissection, and intracorporeal ileal conduit urinary diversion. Pathological findings revealed no residual tumor within the bladder and residual tumor in the prostate. He had discharged without any complications; and quality of life had improved. CONCLUSION A robot-assisted approach might be a potential option for well-selected patients with muscle-invasive bladder cancer who have previously received radiotherapy for localized prostate cancer.
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Affiliation(s)
- Yuka Kubota
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Takuya Hashimoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Naoki Fujita
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Teppei Okamoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yuichiro Suzuki
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hayato Yamamoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Atsushi Imai
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yasuhiro Hashimoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Takuya Koie
- Department of UrologyGifu University Graduate School of MedicineGifuJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan,Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of MedicineHirosakiJapan
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12
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Guo X, Liu M, Hou H, Liu S, Zhang X, Zhang Y, Wu P, Pang C, Wang J. Impact of prostate cancer radiotherapy on the biological behavior and specific mortality of subsequent bladder cancer. Int J Clin Oncol 2019; 24:957-965. [PMID: 30903422 DOI: 10.1007/s10147-019-01427-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/04/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND The impact of different radiotherapy modalities on the development and characteristics of second primary bladder cancers (BCa) and BCa-specific mortality (BCa-SM) remains unclear. Thus, we evaluated the incidence and biological behavior of subsequent BCa and related survival in patients who underwent radiation therapy for prostate cancer (PCa). METHODS A total of 530,581 patients in the surveillance, epidemiology, and end results database with localized PCa between 1988 and 2013 were identified. PCa treatments included radical prostatectomy (RP), external beam radiotherapy (EBRT), radioactive implants (RI), and combined EBRT and RI (EBRI). A multivariable competing risk analysis based on a proportional sub distribution hazards model was used to determine the impact of different radiotherapy modalities on BCa incidence and specific mortality. RESULTS Incidence of BCa was significantly high in patients treated with EBRT, RI, and EBRI vs. RP [sub distribution hazard ratio (SHR) 1.41, P < 0.001; SHR 1.58, P < 0.001; SHR 1.56, P < 0.001, respectively]. BCa following EBRT, RI, and EBRI were more commonly non-urothelial (3.3%, 2.9%, 3.3%, respectively, versus 1.2%) and T4 (3.5%, 6.1%, 5.0%, respectively, versus 1.6%) compared with RP. RI associated with a higher rate of BCa metastasis than RP (2.6% vs. 1.1%). Prior EBRT, RI, and EBRI increased BCa-SM (SHR 1.44, P = 0.001; SHR 1.21, P = 0.047; and SHR 1.42, P = 0.032, respectively). CONCLUSIONS Patients receiving radiotherapy for PCa have a higher risk of BCa. BCa after EBRT, RI, and EBRI is more likely to be non-urothelial, stage T4, and with increased BCa-SM. Prior RI associated with a higher rate of BCa metastasis.
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Affiliation(s)
- Xiaoxiao Guo
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Peking Union Medical College, Beijing, China
| | - Min Liu
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Huimin Hou
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Shenjie Liu
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Xianbo Zhang
- Department of Endocrinology, National Center of Gerontology, Beijing Hospital, Beijing, China
| | - Yaqun Zhang
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Pengjie Wu
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Cheng Pang
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jianye Wang
- Department of Urology, National Center of Gerontology, Beijing Hospital, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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Zhao S, Xie Q, Yang R, Wang J, Zhang C, Luo L, Zhu Z, Liu Y, Li E, Zhao Z. High prevalence of secondary bladder cancer in men on radiotherapy for prostate cancer: evidence from a meta-analysis. Cancer Manag Res 2019; 11:587-598. [PMID: 30666156 PMCID: PMC6331076 DOI: 10.2147/cmar.s185867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective To assess whether radiotherapy (RT) for prostate cancer (PCa) was a risk factor for secondary bladder cancer (BLCa) through a meta-analysis. Materials and methods The MEDLINE, Embase, and the Cochrane Library were systematically searched for all studies investigating the risk of BLCa in patients with RT. The association between RT and risk of BLCa was summarized using hazard ratio with a 95%CI. The protocol for this meta-analysis is available from PROSPERO (CRD42018090075). Results Overall, 619,479 participants (age: 57-79 years) were included from 15 studies, 206,852 of whom were patients who received RT. Synthesis of results indicated that RT was significantly associated with an increased risk of BLCa compared with the risk in those who received radical prostatectomy or non-RT (overall HR=1.6, 95%CI: 1.33-1.92, P<0.001). The results were consistent when restricted to a 5-year lag period (HR=1.84, 95%CI: 1.26-2.69, P=0.002) and multivariable adjustment (HR=1.96, 95%CI: 1.47-2.62, P<0.001), but not for 10-year lag period (HR=1.93, 95%CI: 0.9- 4.16, P=0.093) and brachytherapy subgroup (HR=1.33, 95%CI: 0.87-2.05, P=0.188). The GRADE-profiler revealed that the rate of events of BLCa on average in the RT-patients and the non-RT control was 2,462/183,669 (1.3%) and 4,263/382,761(1.1%), respectively; the overall quality of the evidence was low. Conclusion Patients who received RT for PCa was associated with higher risks of developing secondary BLCa compared to those unexposed to RT, but the absolute effect was low.
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Affiliation(s)
- Shankun Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Qiang Xie
- Department of Reproduction, Southern Medical University Affiliate Dongguan People's Hospital, Dongguan, China
| | - Redian Yang
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Jiamin Wang
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Chaofeng Zhang
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Lianmin Luo
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Zhiguo Zhu
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Yangzhou Liu
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Ermao Li
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
| | - Zhigang Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,
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14
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Feinberg AE, Wallis CJD, Nam RK, Hameed U. Survival and peri-operative outcomes among patients with rectal cancer: the role of prior radiotherapy due to prostate cancer. Int J Colorectal Dis 2019; 34:97-104. [PMID: 30327874 DOI: 10.1007/s00384-018-3175-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/03/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with rectal cancer (RCa) and prior radiation for prostate cancer (PCa) are clinically complicated and may have worse outcomes than other RCa patients. This study investigates the impact of previous radiation for PCa on survival for patients with RCa. METHOD We conducted a population-based study identifying men who underwent surgical treatment of RCa from 2002 to 2010. Patients were classified into three cohorts: no prior PCa, prior PCa treated without radiotherapy, and prior PCa treated with radiotherapy. The primary outcome was overall survival. Secondary outcomes included RCa surgical approach, ICU admission, length of stay, ER visits, and delayed formation of a new stoma. RESULTS Seven thousand ninety-six men underwent surgery for RCa; 6867 patients had no prior PCa, 58 had prior PCa treated without radiotherapy, and 171 had prior PCa treated with radiotherapy. The 5-year overall survival was 62% (95% CI 61-64%) for patients without prior PCa, 46% (95% CI 25-65%) for patients with prior PCa treated without radiotherapy, and 42% (95% CI 29-54%) for patients with prior PCa treated with radiotherapy (p < 0.0001). In multivariable analysis, patients with prior PCa treated with radiotherapy were at increased risk of death (aHR 1.38, 95% CI 1.12-1.69) compared to those without prior PCa. Furthermore, patients with prior PCa treated with radiotherapy had a significantly increased risk of resection with permanent stoma. CONCLUSIONS Prior radiotherapy for PCa is a poor prognostic factor in RCa patients with significantly increased risk of death. Additionally, patients with prior radiotherapy for PCa are more likely to require a permanent stoma.
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Affiliation(s)
- Adina E Feinberg
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Christopher J D Wallis
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Usmaan Hameed
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, North York General Hospital, Toronto, Ontario, Canada
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15
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Fontenot PA, Barnes BD, Parker WP, Wyre H, Lee EK, Holzbeierlein JM. Postoperative Outcomes After Radical Cystectomy in Patients With Prior Pelvic Radiation. Urology 2018; 116:131-136. [PMID: 29545052 DOI: 10.1016/j.urology.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/27/2017] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare complication rates, perioperative outcomes, and survival after radical cystectomy (RC) in patients with prior abdominal or pelvic radiation therapy (RT) vs those without an RT history. MATERIALS AND METHODS We retrospectively reviewed patients undergoing RC for urothelial carcinoma between January 2008 and January 2016. Patients were stratified by receipt of RT, and differences in complications (any, minor, and major) at 30 and 90 days, as well as estimated blood loss, length of surgery, length of hospital stay, and pathologic stage, were compared. Recurrence-free, cancer-specific, and overall survival were compared using the Kaplan-Meier method and log-rank test. RESULTS We identified 518 patients who underwent RC between 2008 and 2016. Of these patients, 55 (11%) had a history of RT. There were no significant differences in complication rates (66% vs 69%, P= .80) between patients who did not and patients who did have a history of RT. Similarly, there were no differences in any perioperative or pathologic outcome by receipt of prior RT (all P>.05). Meanwhile, at a median follow-up of 26 (interquartile range 13-46) months among patients alive at last follow-up, no differences in survival were observed by prior RT (P= .08). CONCLUSION Among patients with a history of prior abdominal or pelvic RT treated at a tertiary referral center, there was no difference in complication rates, perioperative, or pathologic outcomes. Importantly, no differences in survival were noted by prior RT receipt. Therefore, our data support the use of RC, when indicated, in patients with a prior history of abdominal or pelvic RT.
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Affiliation(s)
- Philip A Fontenot
- Department of Urology, University of Kansas Medical Center, Kansas City, KS.
| | - Brian D Barnes
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - William P Parker
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Hadley Wyre
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Eugene K Lee
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
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16
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Charas T, Taggar A, Zelefsky MJ. Second malignancy risk in prostate cancer and radiotherapy. Future Oncol 2017; 13:385-389. [PMID: 28092982 DOI: 10.2217/fon-2016-0503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Tomer Charas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amandeep Taggar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Abstract
Radiation therapy represents an alternative treatment to radical prostatectomy in the management of clinically localized prostate cancer. Radiation-induced second neoplasms are defined by a latency period of at least 5 years, location within the field of radiation therapy, and a histology which differs from the primary tumor. Based on the data in the literature, there is a consistently increased risk of bladder cancer (HR: 1.67, 95% CI 1.55-1.80), rectal cancer (HR: 1.79, 95% CI 1.34-2.38), and colorectal cancer (HR: 1.79, 95% CI 1.34-23.8) following percutaneous radiation therapy. Following brachytherapy only an increased for the development of bladder cancer (HR: 2.14, 95% CI 1.03-3.94) has been observed. The incidence of second neoplasms increases significantly and continuously with the posttreatment time interval. Although bladder cancers following RT of the prostate are usually more locally advanced and of high grade, no negative impact in terms of overall survival and cancer-specific survival has been observed. Symptoms or findings of microhematuria need to be examined thoroughly after radiation therapy to identify bladder cancer quite early.
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19
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Shiota M, Yokomizo A, Takeuchi A, Inokuchi J, Tatsugami K, Ohga S, Sasaki T, Nakamura K, Honda H, Eto M. Smoking effect on secondary bladder cancer after external beam radiotherapy for prostate cancer. Jpn J Clin Oncol 2016; 46:952-957. [DOI: 10.1093/jjco/hyw098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Akira Yokomizo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Saiji Ohga
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomonari Sasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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20
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Keehn A, Ludmir E, Taylor J, Rabbani F. Incidence of bladder cancer after radiation for prostate cancer as a function of time and radiation modality. World J Urol 2016; 35:713-720. [PMID: 27629559 DOI: 10.1007/s00345-016-1934-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the risk of BlCa developing after radiation for PCa, stratified by ethnicity and follow-up duration. METHODS The 1973-2011 surveillance, epidemiology and end results database was used to determine the observed and expected number of BlCa after PCa radiation. The adjusted relative risks (RRs) of developing BlCa were calculated for the various radiation modalities relative to no radiation, stratified by ethnicity and follow-up duration. BlCa characteristics were compared between patients with a history of prostate radiation and those without PCa. RESULTS PCa was radiated in 346,429 men, 6401 of whom developed BlCa versus 2464 expected cases [SIR (95 % CI) of 2.60 (2.53-2.66)]. All radiation modalities were found to have an increased RR of developing BlCa after 10 years, with brachytherapy having a significantly higher RR than external beam radiation (EBRT) or combined EBRT and brachytherapy in Caucasian men and a significantly higher RR than EBRT in men of other/unknown ethnicity. Post-radiation BlCa, in particular that after brachytherapy, had higher grade (P = 0.0001) and lower stage (P = 0.0001) versus the general population. CONCLUSIONS The increased risk of BlCa after prostate radiation occurs predominantly after 10 years, regardless of ethnicity. The RR of developing BlCa after 10 years is significantly higher following brachytherapy than after EBRT or EBRT and brachytherapy. Bladder cancers after prostate radiation, especially after brachytherapy, are generally lower stage but higher grade than those in patients without PCa.
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Affiliation(s)
- Aryeh Keehn
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Ethan Ludmir
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Jacob Taylor
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Farhang Rabbani
- Urology Division, Department of Surgery, Cancer Treatment Centers of America - Southeastern Regional Medical Center, 600 Celebrate Life Parkway, Newnan, GA, 30265, USA.
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Shiota M, Yokomizo A, Takeuchi A, Imada K, Kiyoshima K, Inokuchi J, Tatsugami K, Ohga S, Nakamura K, Honda H, Naito S. Secondary bladder cancer after anticancer therapy for prostate cancer: reduced comorbidity after androgen-deprivation therapy. Oncotarget 2016; 6:14710-9. [PMID: 25900243 PMCID: PMC4546499 DOI: 10.18632/oncotarget.3817] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022] Open
Abstract
Radiotherapy for prostate cancer is associated with an increased incidence of secondary bladder cancer (BC). We investigated the incidence, clinicopathological characteristics, and prognosis of BC after radiotherapy, surgical therapy, and primary androgen-deprivation therapy (ADT) for prostate cancer. This study included 1,334 Japanese patients with prostate cancer treated with radiotherapy (n=631), surgical therapy (n=437), and primary ADT (n=266). During the median follow-up period of 51.2, 44.8, and 45.5 months, secondary BC occurred in 14 (2.2%), 5 (1.1%), and 0 (0%) of patients with prostate cancer treated with radiotherapy, surgical therapy, and primary ADT, respectively. The 10-year BC-free survival rate was 91.3% in the radiotherapy group, 97.4% in the surgical therapy group, and 100% in the primary ADT group. The rates of intravesical recurrence, progression to muscle-invasive BC, and BC-specific death might be higher in secondary BC after radiotherapy compared with after surgical therapy. There was a significant difference in the incidence of secondary BC among different therapeutic modalities for prostate cancer in Japanese men, indicating significantly lower comorbidity rates of secondary BC after primary ADT for prostate cancer compared with radiotherapy.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Yokomizo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenjiro Imada
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keijiro Kiyoshima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Saiji Ohga
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiji Naito
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Guo A, Liu A, Teng X. The pathology of urinary bladder lesions with an inverted growth pattern. Chin J Cancer Res 2016; 28:107-21. [PMID: 27041933 DOI: 10.3978/j.issn.1000-9604.2016.02.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inverted lesions in the urinary bladder have been the source of some difficulty in urological pathology. The two common ones are von Brunn's nests and cystitis cystic/cystitis glandularis, which are considered normal variants of urothelium. Apart from them, a number of other rare urothelial lesions with inverted growth pattern occur in the urinary bladder. Some of them are only reactive conditions, just as pseudocarcinomatous hyperplasia. Some are benign tumors, namely inverted papilloma. Whereas others are malignant neoplasms, including inverted papillary urothelial neoplasm of low malignant potential (PUNLMP), non-invasive inverted papillary urothelial carcinoma (low-grade and high-grade), and invasive urothelial carcinoma (inverted, nested and big nested variants). Because of the overlapping morphological features of all the inverted lesions mentioned above, even between high-grade invasive carcinoma and pseudocarcinomatous hyperplasia which are only a kind of reactive conditions, it is very important for the surgical pathologist to recognize and be familiar with these inverted lesions in urinary bladder. In this article, we review these spectrums of inverted lesions of the urinary bladder. Emphasis is placed on histogenesis, morphology, differential diagnosis of these lesions, and the pathologic grading of the non-invasive inverted neoplasms, such as inverted papilloma, inverted PUNLMP, non-invasive inverted papillary urothelial carcinoma with low-grade, and non-invasive inverted papillary urothelial carcinoma with high-grade.
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Affiliation(s)
- Aitao Guo
- 1 Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China ; 2 Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Aijun Liu
- 1 Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China ; 2 Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xiaodong Teng
- 1 Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China ; 2 Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310058, China
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Tanaka MF, Sonpavde G. Diagnosis and Management of Urothelial Carcinoma of the Bladder. Postgrad Med 2015; 123:43-55. [DOI: 10.3810/pgm.2011.05.2283] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Flannigan RK, Baverstock RJ. Management of post-radiation therapy complications among prostate cancer patients: A case series. Can Urol Assoc J 2014; 8:E632-6. [PMID: 25295135 DOI: 10.5489/cuaj.492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Treating prostate cancer with radiation therapy (RT) is a viable option, albeit with its own profile of complications. We describe a unique Canadian report of a single surgeon (RJB) experience in the management of complex post-prostate cancer RT complications. METHODS We retrospectively analyzed patients who had previously received external beam radiation (XRT) or brachytherapy (BT) for prostate cancer referred to a single surgeon for persistent urologic related difficulties between 2005 and 2010. We used the Radiation Therapy Oncology Group (RTOG) morbidity grading system to assign each patient a 1 to 5 grade for their greatest complication. RESULTS In total, 15 patients were identified with a total of 43 RT-related complications. Of these 43 complications, 19 presented with obstruction, 8 with radiation failure or new bladder cancer, 6 with hematuria, 5 with intractable incontinence, and 5 with urinary tract infections. These patients required several investigations prior to treatment. Treatment of these complications used surgical, local and medical approaches. In the end, 1 patient had total incontinence, 3 improved their incontinence, 3 had self-catheterization and dilation, 1 voided well, 3 underwent cystectomy with ileo-conduits, 2 had chronic hematuria, and 2 passed away. CONCLUSION These patients are heavily investigated and require significant resources, including patient visits, diagnostics and treatment modalities to optimize their condition. Cure is not always possible, but the aim to improve quality of life should guide management.
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Alonzo DG, Mure AL, Soloway MS. Prostate cancer and the increasing role of active surveillance. Postgrad Med 2013; 125:109-16. [PMID: 24113669 DOI: 10.3810/pgm.2013.09.2705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prostate cancer (PC) is the most often diagnosed non-skin cancer and the second leading cause of cancer-related death among men in the United States. As a result, for many years the American Urological Association (AUA) and the American Cancer Society have issued statements recommending screening for PC, resulting in its widespread implementation in the United States. Recently, the United States Preventative Services Task Force gave PC screening a recommendation of D, that is, against PC screening for all men. The AUA countered this recommendation, stating that since the development of PC screening using prostate-specific antigen, a reduction in PC-specific mortality has been seen, and that the risk reduction occurred in a setting in which many of the patients were not aggressively treated for prostate cancer. Active surveillance may be described as a method to potentially delay or obviate the need for treatment in men with clinically insignificant PC or PC thought to be at low risk for progression. Studies have shown no significant difference in outcome or pathology between men with low risk PC who receive treatment at the point of progression and those undergoing immediate treatment. Ongoing studies are evaluating the efficacy and utility of active surveillance for low-risk PC. Interim results of these studies have shown that approximately 30% of patients progress on active surveillance. However, "progression" does not necessarily mean treatment failure; rarely do patients develop locally advanced or metastatic disease. Active surveillance has also been shown to be cost-effective when compared with immediate treatment for PC. Longer follow-up may continue to show an increased benefit of active surveillance as a reasonable initial approach to the management of men with low-risk, clinically localized PC.
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Affiliation(s)
- David Gabriel Alonzo
- The University of Miami Miller School of Medicine, Department of Urology, Miami, FL
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Radical Cystectomy after BCG Immunotherapy for High-Risk Nonmuscle-Invasive Bladder Cancer in Patients with Previous Prostate Radiotherapy. ISRN UROLOGY 2013; 2013:405064. [PMID: 23956880 PMCID: PMC3730135 DOI: 10.1155/2013/405064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/20/2013] [Indexed: 11/17/2022]
Abstract
Purpose. Intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is indicated for high-grade nonmuscle-invasive bladder cancer (NMIBC). The efficacy of BCG in patients with a history of previous pelvic radiotherapy (RT) may be diminished. We evaluated the outcomes of radical cystectomy for BCG-treated recurrent bladder cancer in patients with a history of RT for prostate cancer (PC). Methods. A retrospective chart review was performed to identify patients with primary NMIBC. We compared the outcomes of three groups of patients who underwent radical cystectomy for BCG-refractory NMIBC: those with a history of RT for PC, those who previously underwent radical prostatectomy (RP), and a cohort without PC or RT exposure. Results. From 1996 to 2008, 53 patients underwent radical cystectomy for recurrent NMIBC despite BCG. Those with previous pelvic RT were more likely to have a higher pathologic stage and decreased recurrence-free survival compared to the groups without prior RT exposure. Conclusion. Response rates for intravesical BCG therapy may be impaired in those with prior prostate radiotherapy. Patients with a history of RT who undergo radical cystectomy after failed BCG are more likely to be pathologically upstaged and have decreased recurrence-free survival. Earlier consideration of radical cystectomy may be warranted for those with NMIBC who previously received RT for PC.
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Pseudocarcinomatous urothelial hyperplasia of the bladder: clinical findings and followup of 70 patients. J Urol 2012; 189:2083-6. [PMID: 23228381 DOI: 10.1016/j.juro.2012.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE Pseudocarcinomatous urothelial hyperplasia is rare and almost exclusively described in the pathology literature. MATERIALS AND METHODS We reviewed 70 cases during a 9.5-year period. RESULTS Two specimens were taken from biopsies done at our institution and 68 were from cases referred for consultation. Samples were obtained from a total of 60 men and 10 women with a mean age of 67 years (range 33 to 85). Of 68 patients with information available 52 (76.5%) underwent prior pelvic irradiation, 2 received systemic chemotherapy only, 3 had an indwelling bladder catheter, 2 received intravesical chemotherapy, 1 had been treated with radical prostatectomy, 4 had severe peripheral vascular disease, 1 had an arteriovenous malformation, 1 had sickle cell disease and only 2 (2.9%) had no identifiable contributing factors. Pseudocarcinomatous urothelial hyperplasia developed an average of 54.6 months (range 9 months to 13 years) after prior irradiation. Hematuria was the most common clinical presentation, noted in 45 of 51 patients with data available. Of 48 patients with data endoscopy revealed erythema in 20, a papillary/polypoid lesion in 12, broad-based elevated erythematous lesions in 6, erythematous bullous edema in 5, shallow bleeding ulcers in 4 and prominent trabeculation in 1. Additional findings in the bladder were carcinoma in situ in 3 cases, and dysplasia, low grade papillary urothelial carcinoma and papillary urothelial hyperplasia in 1 each. Three of the 40 patients with an average followup of 27 months (range 1 to 94) subsequently had urothelial carcinoma, including 1 who had prior positive cytology and fluorescence in situ hybridization, 1 with prior high grade papillary urothelial carcinoma and 1 with an unknown history. CONCLUSIONS Although pseudocarcinomatous urothelial hyperplasia mimics invasive urothelial carcinoma clinically and histologically, it is not related to urothelial neoplasms. Almost all patients have causes of bladder ischemia, most commonly a history of remote prior pelvic irradiation.
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Intravesical bacillus Calmette-Guerin immunotherapy after previous prostate radiotherapy for high-grade non-muscle-invasive bladder cancer. Urol Oncol 2011; 31:857-61. [PMID: 21868262 DOI: 10.1016/j.urolonc.2011.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/14/2011] [Accepted: 07/07/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Intravesical bacillus Calmette-Guerin (BCG) immunotherapy is a standard treatment for high-grade non-muscle-invasive bladder cancer (NMIBC). We evaluated outcomes of BCG therapy for NMIBC in patients with a previous history of prostate cancer (CaP) radiotherapy (RT). MATERIALS AND METHODS A retrospective review of patients with a history of CaP RT who subsequently underwent treatment with intravesical BCG for high-grade NMIBC was performed. Patients were categorized as "BCG success" or "BCG failure" (defined as stage progression or recurrent/persistent disease). We evaluated factors related to the radiotherapy (type, interval to BCG), bladder cancer (clinical stage, immunotherapy type, and course), and patient comorbidities, to identify factors associated with BCG failure. RESULTS From 1996 to 2008, 26 patients with high-grade NMIBC received intravesical BCG immunotherapy after CaP RT. At a mean follow-up of nearly 5 years, 13 patients (50%) were successfully managed with one or more induction courses of BCG with or without the addition of interferon alpha. Twelve (46%) eventually required cystectomy for disease recurrence or progression, of which half had pathologically advanced disease (≥pT3). Clinical stage was similar between BCG success and failure patients (P = 0.40). Those who failed immunotherapy were more likely to have had a longer interval between RT and BCG induction (5.8 vs. 2.4 years, P = 0.02). CONCLUSION Approximately 50% of patients with NMIBC who were previously exposed to prostate radiation had a durable response to intravesical BCG. For non-responders, extravesical progression was common.
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Liberman D, Alasker A, Sun M, Ismail S, Lughezzani G, Jeldres C, Budaus L, Thuret R, Shariat SF, Widmer H, Perrotte P, Graefen M, Montorsi F, Karakiewicz PI. Radical cystectomy for patients with pT4 urothelial carcinoma in a large population-based study. BJU Int 2010; 107:905-11. [PMID: 20860649 DOI: 10.1111/j.1464-410x.2010.09590.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE • To examine cancer-specific mortality (CSM) in patients with pT4N₀₋₃ M₀ urothelial carcinoma of the urinary bladder (UCUB) and to compare it to patients with pT3N₀₋₃ M₀, in a population-based cohort treated with radical cystectomy (RC). PATIENTS AND METHODS • RCs were performed in 5625 pT3-T4b₀₋₃ M₀ patients with UCUB within 17 Surveillance, Epidemiology and End Results (SEER) registries between 1988 and 2006. • Univariable and multivariable models tested the effect of pT4a vs pT4b vs pT3 stages on CSM. • Covariates consisted of age, gender, race, lymph node status and SEER registries. • All analyses were repeated in 3635 pN(0) patients. RESULTS • Of 5625 patients, 2043 (36.3%) had pT4aN₀₋₃ , 248 (4.4%) had pT4bN₀₋₃ and 3334 had pT3N₀₋₃ (59.3%) UCUB. • The 5-year CSM was 57.6% vs 81.7% vs 53.9% for, respectively, pT4aN₀₋₃ vs pT4bN₀₋₃ vs pT3N₀₋₃ patients (all log-rank P= 0.008). • In multivariable analyses the rate of CSM was 2.3-fold higher in pT4b vs pT3 (P < 0.001), 1.1-fold higher in pT4a vs pT3 (P= 0.002) and 2.0-fold higher in pT4a vs pT4b patients. • After restriction to pN₀ stage, pT4b patients had a 2.3-fold higher rate of CSM than pT3 patients (P < 0.001) and pT4b patients had a 2.1-fold higher rate of CSM than pT4a patients (P < 0.001). • The CSM rate was the same for pT4a and pT3 patients (P= 0.1). CONCLUSIONS • Our findings indicate that patients with pT4a UCUB have similar CSM as those with pT3 UCUB. • Consequently, RC should be given equal consideration in patients with pT3 and pT4a UCUB.
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Affiliation(s)
- Daniel Liberman
- Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montreal Health Centre, Montreal, Canada
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Jayram G, Katz MH, Steinberg GD. Radical cystectomy in patients previously treated for localized prostate cancer. Urology 2010; 76:1430-3. [PMID: 20381130 DOI: 10.1016/j.urology.2010.01.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/24/2009] [Accepted: 01/16/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To present outcomes of a contemporary series of patients undergoing radical cystectomy (RC) for bladder cancer after previous treatment for localized cancer of the prostate (CaP). METHODS A retrospective review of more than 1000 RCs performed for bladder cancer between 1995 and 2008 identified 49 patients previously treated for localized CaP. Patients were stratified according to the type of primary therapy received for CaP: any form of primary or adjuvant radiotherapy (brachytherapy or external beam radiotherapy) versus radical prostatectomy (RP) monotherapy. Perioperative data were analyzed and compared between the 2 groups. RESULTS Of 49 patients, 40 (82%) underwent primary or adjuvant radiotherapy and 9 (18%) RP alone. Eleven (22%) patients received a continent diversion. Mean estimated blood loss (EBL) and hospital stay were 979 mL and 12 days, respectively. Extravesical disease (≥pT3a) was present in 23 patients (57.5%) in the radiotherapy group and in 2 patients (22%) in the RP group. Ten patients (all in the radiotherapy group) had a positive margin, 9 (90%) of whom had pathologic T4 disease. The overall major perioperative complication rate was 41%. Of the 6 patients with an ONB (all after RP), 4 had severe incontinence. CONCLUSIONS Patients undergoing RC after previous treatment for localized CaP are at increased risk for perioperative morbidity. Patients should be counseled that orthotopic diversion after RP may be associated with significant incontinence. Extravesical disease is more prevalent in patients treated with previous radiation. We observed a high rate of positive margins associated with pathologic T4 disease in this cohort.
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Affiliation(s)
- Gautam Jayram
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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Dallinger B, Würnschimmel E. [Appearance of carcinosarcoma after radiotherapy for local recurrence after radical prostatectomy. Case report and review of the literature]. Urologe A 2010; 49:750-4. [PMID: 20237907 DOI: 10.1007/s00120-009-2217-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carcinosarcoma of the prostate is an extremely rare tumor. In the case of rapid tumor progression, especially after radiation therapy to the pelvis or after hormone deprivation therapy because of prostate cancer, this tumor entity should be considered, and immediate histological confirmation is required. The only curative therapy is immediate radical surgical excision. We report about the first case of a carcinosarcoma after salvage radiation therapy for local recurrence of adenocarcinoma of the prostate years after radical prostatectomy.
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Affiliation(s)
- B Dallinger
- Urologische Abteilung, Krankenhaus Ried im Innkreis, Schlossberg 1, A-4910, Ried im Innkreis, Austria.
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Yee DS, Shariat SF, Lowrance WT, Sterbis JR, Vora KC, Bochner BH, Donat SM, Herr HW, Dalbagni G, Sandhu JS. Impact of previous radiotherapy for prostate cancer on clinical outcomes of patients with bladder cancer. J Urol 2010; 183:1751-6. [PMID: 20299035 DOI: 10.1016/j.juro.2010.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The impact of prostate cancer radiotherapy on the biological behavior of bladder cancer remains unclear. We compared the outcomes of patients with bladder cancer previously treated for prostate cancer with radiotherapy vs other treatment modalities. MATERIALS AND METHODS We identified 144 patients diagnosed with bladder cancer between January 1992 and June 2007 with a previous prostate cancer diagnosis. Clinicopathological data and outcomes were compared between patients with irradiated (brachytherapy and/or external beam radiation therapy 83) and nonirradiated (androgen deprivation therapy, radical prostatectomy and/or surveillance 61) disease. RESULTS Median time between prostate and bladder cancer diagnoses was longer in the irradiated vs nonirradiated group (59 months, IQR 25 to 88, vs 24 months, IQR 2 to 87, p = 0.007). Patients in the irradiated group presented with higher tumor grade (high 92% vs 77%, p = 0.016) and had progression to higher stage disease (muscle invasive 70% vs 43%, p = 0.001) than those in the nonirradiated group. Of the patients undergoing cystectomy those previously treated with radiation had a numerically higher rate of nonorgan confined disease (75% vs 56% for nonirradiated, p = 0.1). Among all patients with bladder cancer 5-year cancer specific survival was 73% (95% CI 59-87) for irradiated vs 83% (95% CI 71-95) for nonirradiated (p = 0.07). Median followup was 53 months (IQR 24 to 75). CONCLUSIONS More time elapsed between prostate and bladder cancer diagnoses for patients treated with radiation, and these patients also presented with more advanced disease. Future studies are needed to further establish clinical differences in bladder cancer between irradiated and nonirradiated cases, and whether biological differences exist.
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Affiliation(s)
- David S Yee
- Urology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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The impact of multiple malignancies on patients with bladder carcinoma: a population-based study using the SEER database. Adv Urol 2009:406965. [PMID: 20069054 PMCID: PMC2801451 DOI: 10.1155/2009/406965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/23/2009] [Indexed: 11/17/2022] Open
Abstract
Purpose. To date, no study has examined a population-based registry to determine the impact of multiple malignancies on survival of bladder cancer patients. Our experience suggests that bladder cancer patients with multiple malignancies may have relatively positive outcomes.
Materials & Methods. We utilized data from the Surveillance Epidemiology and End Results (SEERs) database to examine survival between patients with only bladder cancer (BO) and with bladder cancer and additional cancer(s) antecedent (AB), subsequent (BS), or antecedent and subsequent to bladder cancer (ABS).
Results. Analyses demonstrated diminished survival among AB and ABS cohorts. However, when cohorts were substratified by stage, patients in the high-stage BS cohort appeared to have a survival advantage over high-stage BO patients.
Conclusions. Bladder cancer patients with multiple malignancies have diminished survival. The survival advantage of high-stage BS patients is likely a statistical phenomenon. Such findings are important to shape future research and to improve our understanding of patients with multiple malignancies.
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The risk and prophylactic management of bladder cancer after various forms of radiotherapy. Curr Opin Urol 2009; 19:500-3. [PMID: 19553822 DOI: 10.1097/mou.0b013e32832eb3b3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Prostate cancer is the most common cancer diagnosed in men and remains the second most lethal malignancy. Most patients undergoing treatment elect for radical prostatectomy or radiation. As the number of patients treated has increased and survival improved, delayed complications of these modalities has assumed increased importance. Recent studies report an increased risk of certain cancers after radiation for prostate cancer. This review aims to summarize recent data. RECENT FINDINGS Recent studies have confirmed the association of prostate radiation with secondary cancers. The most common secondary malignancy is bladder carcinoma. We have treated 44 patients with bladder cancer who had radiation therapy for prostate cancer. At diagnosis, 60% had tumor, which invaded the bladder muscle (T2 or greater disease). The mean latency from radiation to diagnosis of bladder cancer was 5.5 years. SUMMARY Radiation therapy for prostate cancer is associated with an increased risk of bladder cancer. In our series, patients presented at higher stage than expected from population-based studies of bladder cancer. Patients and their physicians should be aware of such risks when choosing therapy for prostate cancer. Hematuria following radiation therapy for prostate cancer should be investigated rather than being attributed to radiation-induced cystitis.
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Soloway MS. Editorial comment. Urology 2009; 74:871-2; author reply 872. [PMID: 19800511 DOI: 10.1016/j.urology.2009.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 04/06/2009] [Accepted: 04/06/2009] [Indexed: 11/25/2022]
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Abstract
Background: This study quantified the risk of urinary bladder neoplasms in cancer patients taking into account the age at first diagnosis, the gender of the patients and the lead time between diagnoses. Methods: We used standardised incidence ratios (SIRs) to compare the incidence of bladder tumours in 967 767 cancer patients with the incidence rate in the general Swedish population. A total of 3324 male and 1560 female patients developed bladder tumours at least 1 year after first cancer diagnosis. Results: After bladder and renal pelvis cancers, the SIRs of bladder neoplasms were higher in female than in male patients. Men affected by lung, stomach and larynx tumours belonged to the population at high risk for bladder cancer. Treatment of breast, ovarian and cervical cancers seems to contribute to the subsequent development of bladder neoplasms. Long latencies (16–25 years) were observed after testicular, cervical and endometrial cancers. Detection bias had an important role after prostate cancer. Chemotherapy with cyclophosphamide and cisplatin, and also radiotherapy, seem to increase the risk of subsequent neoplasms in the bladder. Conclusions: These population-based results may help urologists to assess the risk of bladder neoplasms in cancer survivors. Our data should guide ongoing studies that investigate the effectiveness of bladder cancer screening in cancer patients.
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Zhang H, Bermejo JL, Sundquist J, Hemminki K. Prostate cancer as a first and second cancer: effect of family history. Br J Cancer 2009; 101:935-9. [PMID: 19690542 PMCID: PMC2743371 DOI: 10.1038/sj.bjc.6605263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/09/2009] [Accepted: 07/23/2009] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diagnosis with prostate cancer has been reported to increase the risk of subsequent tumours. However, specific data on individuals with a parental history are not available so far. METHODS On the basis of the nationwide Swedish Family-Cancer Database including 18,207 primary invasive prostate cancers, standardised incidence ratios (SIRs) were used to estimate the relative risks of subsequent tumours after prostate cancer in the general population and among individuals with a parental history of cancer. RESULTS A significantly increased SIR of colorectal cancer was found among prostate cancer patients with a parental history of colorectal cancer (2.26, 11 cases). The SIRs of parental concordant (same site) tumours after prostate cancer were also increased for urinary bladder cancer (4.42, 4 cases) and chronic lymphoid leukaemia (38.0, 2 cases). CONCLUSION A higher than additive and multiplicative interaction was observed between the individual history of prostate cancer and parental history of colorectal and urinary bladder cancers, although the number of cases did not permit the rejection of any interaction model. The results suggest that the occurrence of second tumours, for example bladder after prostate or prostate after bladder tumours, is mostly related to shared genetic and non-genetic risk factors rather than treatment of first cancer.
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Affiliation(s)
- H Zhang
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - J L Bermejo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö 20502, Sweden
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Center for Family and Community Medicine, Karolinska Institute, Alfred Nobels alle 12, Huddinge 14183, Sweden
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Capitanio U, Isbarn H, Shariat SF, Jeldres C, Zini L, Saad F, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Partial cystectomy does not undermine cancer control in appropriately selected patients with urothelial carcinoma of the bladder: a population-based matched analysist. Urology 2009; 74:858-64. [PMID: 19628260 DOI: 10.1016/j.urology.2009.03.052] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/11/2009] [Accepted: 03/25/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cancer control outcomes after partial cystectomy (PC) are not well studied. We compared the population-based rates of overall (OS) and cause-specific survival (CSS) in patients with urothelial carcinoma of the urinary bladder (UCB) treated with PC or radical cystectomy (RC). METHODS Within the Surveillance Epidemiology and End Results-9 database, we identified 7243 patients treated with PC (n = 1573) or RC (n = 5670), who had pathologic T(1-4)N(1-2)M(0) UCB. Matched Kaplan-Meier survival analyses compared the effect of PC vs RC on OS and CSS. RESULTS In the entire cohort, the OS and CSS estimates at 5 years were 57.2% and 76.4%, respectively, for PC patients and 50.2% and 65.8%, respectively, for RC patients (P < .001). In the cohort matched for age, race, pT stage, pN stage, tumor grade, and year of surgery, at 5 years the OS and CSS estimates were 56.0% and 73.5%, respectively, for PC patients, and 50.9% and 67.5%, respectively, for RC patients (OS, P = .03 and CSS, P < .001). When the number of removed lymph nodes was added to the matching criteria, the 5-year OS and CSS estimates were 57.2% and 70.3%, respectively, for PC patients, and 54.6% and 69.2%, respectively, for RC patients (HR 1.1, P = .3 and HR 1.1, P = .5). CONCLUSIONS Partial cystectomy does not undermine cancer control in appropriately selected patients with UCB.
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Herr HW, Carver B. Effect of Radiation-Associated Second Malignancies on Prostate Cancer Survival. Urology 2008; 72:968-70. [DOI: 10.1016/j.urology.2008.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 05/21/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
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Reply by Authors. J Urol 2008. [DOI: 10.1016/j.juro.2008.07.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Konety BR. Commentary on the etiologic relationship between prostate radiation and bladder cancer: the scourge for one is poison for the other. J Urol 2008; 179:S12-3. [PMID: 18405739 DOI: 10.1016/j.juro.2008.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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