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

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

doi:10.1016/j.urolonc.2025.04.007

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

Urol Oncol. 2025 May 24:S1078-1439(25)00151-6. doi: 10.1016/j.urolonc.2025.04.007. Online ahead of print.

Authors

Alexander C Martin¹, Ian M McElree², Sarah L Mott³, Helen Y Hougen¹, Ryan L Steinberg¹, Michael A O'Donnell¹, Vignesh T Packiam⁴

Affiliations

¹ Department of Urology, University of Iowa, Iowa City, IA.
² University of Iowa Carver College of Medicine, Iowa City, IA.
³ Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA.
⁴ Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. Electronic address: vignesh.packiam@rutgers.edu.

PMID: 40414744
DOI: 10.1016/j.urolonc.2025.04.007

Abstract

Objectives: To characterize the oncologic outcomes in patients with high-grade noninvasive urothelial carcinoma of the prostate (NMIUC-P) treated with intravesical therapy and assess for clinicopathologic features associated with response.

Subjects and methods: Patients with high-grade NMIUC-P treated with intravesical Bacillus Calmette-Guerin (BCG) or chemotherapy between 2005 and 2021 were retrospectively analyzed. Survival probabilities were estimated using the Kaplan-Meier method. Cox regression was used to evaluate the effect of clinicopathologic and treatment characteristics on high-grade recurrence-free survival (HG-RFS) and progression-free survival (PFS).

Results: A total of 62 patients with median follow-up of 38 months (IQR 19-74) were included. NMIUC-P pathology was carcinoma in situ containing in 52 (84%), high-grade Ta in 9 (14%), and high-grade T1 in 1 (2%). Fifty (80%) patients had concomitant bladder UC. Induction regimens were BCG (44%), gemcitabine/docetaxel (42%), and other chemotherapies (14%). HG-RFS was 45%, 43%, and 38% at 1, 2, and 3 years, respectively. Seventeen patients (27%) underwent cystectomy at a median of 12 months, of whom 5 (29%) had ≥T2 and 3 (18%) had N+ disease. Among all patients, PFS was 87%, 69%, and 69% at 1, 2, and 3 years, respectively. Cystectomy-free, cancer-specific, and overall survival were 65%, 92%, and 83% at 3 years, respectively. No clinicopathologic or treatment characteristics were significantly associated with HG-RFS.

Conclusion: In a high-risk cohort of patients with NMIUC-P, a select number of patients were able to avoid cystectomy and remain recurrence-free at 3-years after pursuing bladder-sparing intravesical treatment. However, given the high incidence of disease progression, careful patient selection is critical. Further prospective studies are needed to identify markers of response.

Keywords: BCG; Bladder cancer; Docetaxel; Gemcitabine; Prostatic urethral.