Prostate sparing radical cystectomy--not for all, but an option for some

Prostate sparing radical cystectomy (PSRC) is a controversial surgical approach for the treatment of male bladder cancer. The objective of this review is to address some of the concerns related to the potential compromise of oncological outcome compared to radical cystoprostatectomy (RCP)-the gold standard procedure.

Review of series published in the English literature. Only studies that address PSRC for transitional cell carcinoma of the bladder were included.

There are only a limited number of studies addressing this approach. All are retrospective, non-comparative and not uniform in terms of patient selection and technique. Long-term follow-up is lacking. The incidence of synchronous and or metachronous prostate cancer and TCC of the prostatic urethra is lower than that found in RCP due to pre-operative screening. The local recurrence rate is 5%- comparable with RCP. Stage for stage, recurrence free and overall survival are compatible.

The experience with PSRC is too limited to allow firm conclusions as to whether the outcome with respect to disease free and disease specific survival is comparable to that achieved by RCP. However, with proper patient screening and selection the short-term results appear promising.