Cancer Resources > Cancer News > 2000 > November

Prostate cancer prognosis with bladder neck involvement better than expected

Last Updated: 2000-09-29 18:08:13 EDT (Reuters Health) - A retrospective review of radical prostatectomy patients indicates that those with bladder neck involvement have a lower risk of disease progression than those with seminal vesicle invasion, Israeli researchers report.

This is contrary to the current tumor, node and metastasis (TNM) classification of prostate cancer, which considers bladder neck involvement a significantly advanced, or stage T4a, disease, while seminal vesicle invasion is classified as T3c disease, Dr. Ofer Yossepowitch and colleagues write in the September issue of Urology.

Dr. Yossepowitch's team, from the Rabin Medical Center, in Petah-Tikva, analyzed pre- and postoperative clinical and pathologic data for 286 consecutive radical prostatectomy patients. The researchers identified 25 patients with pathologic bladder neck involvement and 26 patients with seminal vesicle invasion.

"The overall disease recurrence rate...was 62% in [those with seminal vesicle invasion] and only 36% in the [bladder neck involvement] group," the researchers write. They defined disease progression as a prostate-specific antigen (PSA) level of 0.2 ng/mL and rising.

A mean follow-up of 30.8 months in the bladder neck involvement group showed no progression to metastatic disease. Conversely, during a mean follow up of 40.8 months, 20% of those with seminal vesicle invasion showed metastatic disease progression.

Dr. Yossepowitch's group adds, "It appears that bladder neck involvement in the pathologic specimen does not carry such a dismal prognosis and that seminal vesicle involvement is definitely an ominous prognostic sign."

"Bladder neck involvement in the surgical specimen should not be included with the pathologic T4 subgroup," Dr. Yossepowitch and colleagues conclude. They believe that modification of the TNM staging system should be considered.

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