Poulos CK et al. (2004) Bladder neck invasion is an independent predictor of prostate-specific antigen recurrence. Cancer 101: 1563–1568

The classification of prostate cancer with bladder neck involvement as pT4 disease in the TNM staging system is controversial. Poulos et al. have studied the prognostic significance of bladder neck invasion in 364 consecutive patients undergoing radical prostatectomy.

Bladder neck involvement—defined as infiltration by neoplastic cells within the smooth muscle bundles of the coned bladder neck— was recorded in 22 (6%) of the prostatectomy specimens. Involvement was significantly associated with preoperative PSA level, PSA recurrence (defined as a PSA level of ≥0.1 ng/ml), high pathological classification (using the 1997 TNM system), larger tumor volume, positive surgical margins or extraprostatic extension. Multivariate analysis showed that bladder neck involvement was an independent predictor of early PSA recurrence: adjusting for pathological classification, Gleason score and surgical margin status, PSA recurrence was approximately three times more likely in men with bladder neck involvement than in those without (adjusted odds ratio 3.3, 95% confidence interval 1.04–10.03, P = 0.04).

This is the first demonstration of the independent prognostic significance of bladder neck invasion in prostate carcinoma. The authors note that the results should be considered preliminary, since the sample size was small and the mean follow-up was only 14 months. They conclude, however, that tumors with bladder neck involvement should be placed in a category that reflects their prognostic significance.