Abstract

BACKGROUND:

In patients with non-invasive urothelial carcinoma of the prostatic urethra (PUC), treatment with Bacillus Calmette-Guárin (BCG) could be beneficial.

OBJECTIVE:

To assess the response rates to BCG in the different tumor stages, to describe the clinical impact of transurethral resection of the prostate (TURP) before BCG treatment, and to review the side effects of BCG treatment for PUC.

METHODS:

A systematic search was conducted using the PubMed database to identify original studies between 1977 and 2019 reporting on PUC and BCG.

RESULTS:

Of a total of 865 studies, ten were considered for evidence synthesis. An indication for BCG treatment was found in non-stromal invasive stages (Tis pu, Tis pd) and in stromal infiltrating cases (T1) of primary and secondary PUC when transitional cell carcinoma was the histology of origin. Studies including patients treated with TURP before BCG showed a better local response in the prostatic urethra with a higher DFS (80–100% vs. 63–89%) and PFS (90–100% vs. 75–94%) than patients in studies in which no TURP was performed. However, this difference in recurrence and progression in the prostate neither affected the total PFS (57–75% vs. 58–93%), nor the disease specific survival (70–100% vs. 66–100%).

CONCLUSIONS:

The use of resection loop biopsies of the prostatic urethra in appropriate cases during the primary work-up for suspected PUC, as well as the use of the current TNM classification for PUC, need to be improved. BCG therapy for non-stromal invasive stages of PUC show a good local response. Local response is further improved by a TURP before BCG therapy, although the overall prognosis does not seem to be affected. Further evidence for BCG treatment in the rare cases of stromal invasive PUC is needed. Specific side effects of BCG treatment for PUC are not reported.

中文翻译：

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卡介苗在治疗尿道前列腺部尿路上皮癌中作用的系统评价

 抽象的

 背景：

对于前列腺尿道非浸润性尿路上皮癌 (PUC) 患者，卡介苗 (BCG) 治疗可能有益。

 客观的：

评估不同肿瘤阶段对卡介苗的反应率，描述卡介苗治疗前经尿道前列腺电切术 (TURP) 的临床影响，并回顾卡介苗治疗 PUC 的副作用。

 方法：

使用 PubMed 数据库进行系统检索，以确定 1977 年至 2019 年间报告 PUC 和 BCG 的原始研究。

 结果：

在总共 865 项研究中，有 10 项被考虑进行证据综合。当移行细胞癌是组织学来源时，在原发性和继发性 PUC 的非间质浸润期（Tis pu、Tis pd）和间质浸润病例（T1）中发现了 BCG 治疗的指征。包括在 BCG 之前接受 TURP 治疗的患者的研究显示，与接受 TURP 治疗的患者相比，尿道前列腺部有更好的局部反应，具有更高的 DFS（80-100% vs. 63-89%）和 PFS（90-100% vs. 75-94%）。未进行 TURP 的研究。然而，前列腺复发和进展的这种差异既不影响总 PFS（57-75% 与 58-93%），也不影响疾病特异性生存率（70-100% 与 66-100%）。

 结论：

在疑似 PUC 的初步检查期间，在适当的病例中使用前列腺尿道切除环活检，以及对 PUC 目前的 TNM 分类的使用都需要改进。 BCG 治疗 PUC 非间质浸润期显示出良好的局部反应。 BCG 治疗前进行 TURP 可以进一步改善局部反应，但总体预后似乎并未受到影响。对于罕见的间质侵袭性 PUC 病例，需要进一步的证据来证明 BCG 治疗。 BCG 治疗 PUC 的具体副作用尚未报道。