Transitional Cell Carcinoma of the Prostate

Medically Reviewed by Nazia Q Bandukwala, DO on May 17, 2022
4 min read

A rare form of prostate cancer is called transitional cell carcinoma of the prostate, or urothelial carcinoma of the prostate. It’s very dangerous, but it can be treated successfully if it’s found early enough.

Transitional, or urothelial, cells make up the lining inside parts of the urinary tract. They’re in the bladder, urethra, and ureters. They’re flexible and can stretch and move as your body needs without coming apart.

In men, a section of the urethra runs through the prostate gland. There it connects with ducts that supply prostate fluid and seminal fluid during ejaculation. Transitional cell carcinoma of the prostate starts in this section of the urethra or in the prostate ducts.

This kind of cancer tends to be very aggressive. That means it spreads easily to other parts of the prostate gland, the bladder, and the seminal vesicles. It can get into nearby lymph nodes and even spread far throughout the body to the bones and organs like the lungs and liver.

It’s a very rare disease, accounting for less than 5% of all prostate cancer cases.

  • Men in middle age are the ones most likely to get transitional cell carcinoma of the prostate. The average age at the time of diagnosis is 54. For all forms of prostate cancer, most men are at least 65 when they’re diagnosed.
  • Most men who get this kind of cancer also have bladder cancer, which is another type that mainly involves transitional, or urothelial, cells. It usually starts there and spreads to the prostate. But it can also start in the prostate and spread to the bladder.
  • Smoking and working with certain industrial chemicals are known to raise your risk for cancer in transitional cells.

This disease is hard to diagnose. It’s often mistaken for something else at first. That’s partly why it’s hard to treat successfully. By the time it’s caught, it’s usually already advanced.

The symptoms are the same as for other kinds of prostate problems. You may have:

  • A hard time peeing
  • Pain or irritation when you pee
  • Blood in your urine

The level of prostate specific antigen (PSA) in your blood, which is often an early clue you have prostate cancer, may not be high when you have this kind. Cancerous urothelial cells don’t make PSA.

Your prostate will feel hard or lumpy in a digital rectal exam, but that isn’t usually how it’s diagnosed.

Most men find out they have transitional cell carcinoma of the prostate after they’ve had a transurethral resection of the prostate. That’s a procedure to treat urinary problems caused when your prostate becomes enlarged.

A surgeon inserts an instrument into the urethra through the end of the penis. With either an electric current or laser, they cut away pieces of prostate tissue. When they look at that tissue under a microscope, they can spot cancerous urothelial cells.

The treatment you’ll get depends on whether the cancer has spread.

  • Surgery. If it’s only located in the place where it started, known as "in situ," your doctor may recommend surgery to remove the tumor and possibly some surrounding tissue. Another option is a more extensive surgery called a cystoprostatectomy that removes the whole prostate plus the bladder, seminal vesicles, and lymph nodes.
  • Immunotherapy. After surgery, you may have something called Bacillus Calmette-Guérin treatment. It’s a way of training your immune system to fight the cancer. It involves a germ related to the one that causes tuberculosis. Your urinary tract is flushed with a solution that contains the germ. This causes your immune system to attack any cancer cells that may have been left behind.
  • Radiation. You may have radiation treatment after surgery to kill any remaining cancer cells and keep the disease from coming back. It’s also an option for transitional cell carcinoma that has spread into other parts of the prostate and some surrounding tissue.
  • Chemotherapy. Chemotherapy may be used when the cancer has spread to the lymph system or other parts of the body.

Because this disease usually isn’t diagnosed until the cancer is advanced, it’s very hard for treatment to be successful. Once the cancer has spread to other parts of the prostate or to the surrounding tissues, men may not live more than another 3 years.

But if the cancer stays confined to the place it started – either the prostatic urethra or the prostatic ducts – it’s possible to remove it completely. Some studies found men with this kind of cancer who got surgery had a survival rate of 100%. That means they were just as likely to live at least another 5 years as men who don’t have cancer. That’s similar to the survival rate for other kinds of prostate cancer that are caught early.