Primary transitional cell carcinoma of the prostate: a male disease with dismal prognosis despite cisplatin-based systemic chemotherapy

Abstract 

Background

Primary urothelial carcinoma of the prostate is an infrequent male malignancy with a dismal prognosis, that originates in the periurethral prostatic gland. This neoplasia is considered, in general terms, to be chemosensitive but prospective trials regarding therapy and prognosis are lacking, due to the infrequent nature of this entity. This paper is a case series regarding the accumulated experience in our institution with the use of cisplatin-based chemotherapeutic regimens in these patients.

Methods

The clinico-pathological findings of a series of 12 patients with primary urothelial carcinoma of the prostate diagnosed and treated over a 10 year period are reviewed, with an emphasis on therapy and evolution.

Results

No patient in the series reached long-term survival. Mean time to death was 24.1 months (range 5–48 months). The combination of local treatment plus cisplatin-based systemic chemotherapy did not achieve satisfactory results. However, patients treated with radical surgery (cystectomy or prostatectomy) and at least 3 cycles of multiple chemotherapy behaved better than the rest. Radical surgery achieved better local control than radiotherapy, but repeated transurethral resection of the prostate plus systemic chemotherapy may also provide local control in selected patients.

Conclusion

Despite combined therapeutic efforts that pursued both local control and the prevention of a systemic relapse, the prognosis of advanced primary prostatic urothelial carcinoma remains dismal. Early diagnosis appears difficult because clinical presentation differs to that of males with adenocarcinoma of the prostate or invasive transitional cell carcinoma (TCC) of the bladder. Cisplatin-based systemic chemotherapy does not allow prolonged survival.

Keywords: Prostate neoplasm, Transitional cell carcinoma, Squamous cell carcinoma, Diagnosis, Treatment, Prognosis