Prostate Involvement in Bladder Cancer: Prevalence and Associated Risk Factors in Patients Undergoing Radical

Abstract

Bladder cancer (BC) is a major malignancy, and prostate involvement is a critical clinical concern influencing prognosis and treatment. Current BC management includes neoadjuvant chemotherapy followed by radical cystectomy, with emerging immunotherapies offering promising new avenues. Prostate involvement, reported in 15–48 of radical cystectomy cases, may occur via direct invasion or urethral spread, with stromal invasion indicating a worse prognosis. Risk factors include bladder carcinoma in situ (CIS), multifocal tumors, bladder neck involvement in prostate involvement, higher tumor grade/stage, and prior pelvic radiotherapy. Methods This retrospective study investigated the prevalence and risk factors for prostate involvement in 281 patients with BC who underwent radical cystoprostatectomy at Alzahra and Khorshid Hospitals, Isfahan, Iran, between 2017 and 2022. Data were collected from medical records on demographics, pathological findings (tumor stage, lymph node involvement, prostate involvement, tumor size, and distance from the bladder neck), and PSA levels. Statistical analysis was performed using SPSS v26, employing the Chi-square test, independent t-test, and Mann–Whitney U test. Results Prostate involvement was observed in 13.9 (39/281) of patients. Significant correlations were found between prostate involvement and higher tumor stage (P-value<0.001), lymph node involvement (P-value<0.001), larger tumor size (P-value=0.009), shorter distance to the bladder neck (P-value<0.001), and higher PSA levels (P-value<0.001). No significant relationship was found with age, smoking, or hospital type. Conclusions Prostate involvement in BC is relatively common. Higher tumor stage, lymph node involvement, larger tumor size, and proximity to the bladder neck are key predictors. These findings highlight the need for a comprehensive evaluation of high-risk BC patients to improve treatment planning and oncological outcomes. Copyright © 2026 Urology Research Center (URC), Tehran University of Medical Sciences.