Abstract
We aim to investigate the significance of intravesical prostate protrusion (IPP) on the prognosis of non-muscle invasive bladder cancer (NMIBC) after the transurethral resection of bladder tumors (TURBT). For newly diagnosed NMIBC, we retrospectively analyzed the association between prognosis and IPP for at least a 5-year follow-up. A degree of IPP over 5 mm in a preoperative CT scan was classified as severe. The primary endpoint was recurrence-free survival, and the secondary endpoint was progression-free survival. The machine learning (ML) algorithm of a support vector machine was used for predictive model development. Of a total of 122 patients, ultimately, severe IPP was observed in 33 patients (27.0%). IPP correlated positively with age, BPH, recurrence, and prognosis. Severe IPP was significantly higher in the recurrence group and reduced in the recurrence-free survival group (p = 0.038, p = 0.032). Severe IPP independently increased the risk of intravesical recurrence by 2.6 times. The addition of IPP to the known oncological risk factors in the prediction model using the ML algorithm improved the predictability of cancer recurrence by approximately 6%, to 0.803. IPP was analyzed as a potential independent risk factor for NMIBC recurrence and progression after TURBT. This anatomical feature of the prostate could affect the recurrence of bladder tumors.
Highlights
Published: 20 September 2021Intravesical prostatic protrusion (IPP) is a phenomenon in which the prostate adenoma, mainly the median lobe, grows into the bladder along the least resistant plane, which can occupy the bladder space at a measurable capacity [1]
We investigated the effect of intravesical prostate protrusion (IPP) on the prognosis of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumors (TURBT) through analysis of long-term data, over 5 years, with machine learning (ML) algorithms
We evaluated the correlation between IPP, aging, and benign prostatic hyperplasia (BPH)
Summary
Published: 20 September 2021Intravesical prostatic protrusion (IPP) is a phenomenon in which the prostate adenoma, mainly the median lobe, grows into the bladder along the least resistant plane, which can occupy the bladder space at a measurable capacity [1]. IPP may be a better noninvasive predictor of bladder outlet obstruction than routine prostatic volume [2]. While lateral bilobular hyperplasia of the prostate can cause compression of the prostatic urethra, IPP of the median lobe may trigger a “ball-valve” type of obstruction, distorting the funneling effect of the normal prostatic-urethral angle and disrupting laminar flow at the bladder neck, leading to dyskinetic movement of the bladder neck during micturition [3]. A strong bladder contraction force to open a channel between the lobes can aggravate the “ball-valve” effect in IPP [4]. A high degree of IPP has been associated with a high postvoid residual urine volume (PVR) [1].
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