Prostatic biology, histologic patterns and clinical consequences of transitional cell carcinoma

PURPOSE OF REVIEW: To review the current fund of knowledge about prostatic transitional cell carcinoma and the implications for diagnostic and management strategies particularly as they relate to radical cystectomy. RECENT FINDINGS: Prostatic transitional cell carcinoma (TCC) is present in up to 48% of patients undergoing radical cystoprostatectomy. Transurethral resection biopsies of the prostatic urethra are a sensitive means of detecting prostatic TCC and whole-mount step sectioning is the most accurate method for determining the presence and extent of prostatic TCC. Prostatic TCC may affect prognosis independent of the primary bladder tumor stage. Preoperative detection of prostatic TCC enables accurate staging and treatment planning, including assessment of the risk of cancer at the apical urethral margin and the risk of a second primary tumor of the retained urethra, all of which factor into decision-making around urinary diversion and urethrectomy. Recognition of true T4a stage requires consideration of neoadjuvant chemotherapy and the need for extended pelvic and iliac lymphadenectomy in order to optimize an integrated treatment strategy. SUMMARY: Prostatic involvement with TCC in patients with bladder cancer is a common event. In patients with recurrent high-grade nonmuscle invasive cancer and patients undergoing radical cystoprostatectomy, a thorough assessment of the prostatic urethra and stroma is imperative for accurate staging and treatment planning.