Editing Urothelial Cancer of the Prostate (section)

== Management ==

* '''Based on the degree or depth of involvement'''
** '''See 2015 CUA NMIBC Guideline Notes'''
*** '''pTis pu (CIS of the prostatic urethra) or visible prostatic urethra tumour concomitant with NMIBC of the bladder: TURP then BCG.'''
**** BCG is given after TURP for accurate staging and increasing efficacy by increasing surface area
*** '''pTis pd (CIS involving the prostatic ducts): treatment controversial, consider TURP + BCG'''
**** Despite good response to BCG, prostatic ductal involvement has potential for invasion, and if invasion occurs there is a high risk of metastasis.
*** '''Re-biopsy of the prostatic urethra is recommended after BCG to detect recurrences early'''
**** '''Recurrence of any HG lesion in prostatic urethra after TURP + BCG: consider radical cystectomy plus urethrectomy'''
***** If patient prefers bladder-sparing approach, consider repeat BCG or intra-vesical gemcitabine
*** '''pT2 (prostatic stromal invasion (pT2): radical cystectomy +/- urethrectomy'''
**** '''Consideration of urethrectomy should be made, especially if tumor is present near or at the surgical margin'''
** Campbell’s:
*** For patients with non-invasive prostatic urethral cancer, TURP with BCG therapy is appropriate. For patients with prostatic ductal disease, complete TURP is warranted, plus BCG therapy
*** Prostatic stromal invasion is a poor prognostic factor and is treated with multimodal therapy combining chemotherapy and radical cystectomy