The Journal of Urology relationship between bladder and prostate caners?

[Guest guest]

http://www.jurology.com/article/S0022-5347(08)00553-3/fulltext

In the preceding article Singh et al report that men

with prostate cancer are at increased risk for bladder cancer and vice versa.

Interestingly, there was no increase in other malignancies such as lung, kidney

or colon cancer. The authors conclude that there may be a common carcinogenic

pathway between prostate and bladder cancers that should be further explored.

More importantly, and perhaps clinically relevant, the

authors acknowledge that hematuria after prostate cancer treatment should not

be assumed to be a benign treatment related side effect. Previous retrospective

studies have demonstrated that patients with bladder cancer often have a delay

in diagnosis. While in the current study there was no statistical difference in

stage distribution of primary or secondary bladder cancers, there did appear to

be a trend towards diagnosis before muscle invasive disease in the secondary

cancers. Mommsen et al reported on the time to diagnosis in 212 consecutive

patients with bladder cancer.1 They found that the mean time

from initial symptom to treatment was 28 weeks, with the longest time delay for

patients with cystitis and women with hematuria. Mansson et al similarly

reported a greater delay in diagnosis in women compared to men and those with

only urgency compared to those with hematuria and pain.2 Other authors have demonstrated a

poorer outcome for patients with more than a 3-month delay until cystectomy.3, 4 Thus, Singh et al appropriately conclude that

patients with hematuria following prostate cancer should be evaluated

appropriately and in a timely fashion for the possibility of urothelial cancer.

Singh et al also stratified the risk of urothelial

cancer after prostate cancer by treatment with or without radiation therapy,

and found no difference in the standardized incidence ratio (SIR). However, the

sample size in this analysis was small and therefore not generalizable.

However, this finding is in contrast to multiple other population based studies

that have clearly documented an increased risk of urothelial cancer following

radiation therapy for prostate cancer. Neugut et al evaluated the records of

141,761 men from the SEER (Surveillance, Epidemiology and End Results) database

in the pre-prostate specific antigen era (1973 to 1990) and demonstrated a

relative risk of 1.5 of developing bladder cancer after radiotherapy for

prostate cancer.5 Brenner et al also evaluated a

relatively similar cohort of men from the SEER database from 1973 to 1993 and

reported that radiotherapy for prostate cancer was associated with an increased

risk of bladder cancer (up to 34%) compared to prostatectomy.6 More recently, Boorjian et al

used data from the CaPSURE® database to evaluate the risk of bladder cancer in

a more contemporary group of patients diagnosed with prostate cancer from 1989

to 2003.7 In a multivariate analysis that

adjusted for comorbidity and smoking status, the authors found a lower relative

risk of bladder cancer among patients who underwent prostatectomy compared to

radiotherapy (odds ratio 0.51). They also found an overall cumulative incidence

of bladder cancer of 1.5% among all patients with prostate cancer.

Thus, the study by Singh et al is important for

several reasons. It highlights a possible carcinogenic pathway between 2

urological cancers, it may stimulate physicians to be more vigilant in evaluating

any hematuria following prostate cancer and it suggests that some patients with

prostate cancer (ie smokers and those who have received radiation therapy)

should potentially be screened for urothelial cancer.