Prostate cancer in patients with the bladder exstrophy-epispadias complex: insights and outcomes

With modern reconstructive surgical techniques and better neonatal intensive care unit care, patients with the bladder exstrophy-epispadias complex are now living much longer than they did previously. As these patients age, the men will begin to seek out adult urologists for common conditions such as benign prostatic hyperplasia and prostate cancer screening. We present the first known man with the exstrophy-epispadias complex to be diagnosed with prostate cancer.

After obtaining institutional review board approval, the computerized charting system at our institution was used to review this patient's medical record. A computerized literature search was then conducted using PubMed to confirm that no other cases of prostate cancer had been reported in the exstrophy-epispadias population.

The patient underwent radical retropubic prostatectomy by an adult urologic oncologist assisted by a pediatric urologist with expertise in bladder exstrophy. The patient later required cystectomy and ileal conduit for disease at the bladder neck, as well as external beam radiotherapy and androgen deprivation therapy. During 1 year of follow-up, his prostate-specific antigen level was undetectable.

We have described the first case of prostate cancer in the exstrophy-epispadias population, proving that these patients are at risk and that radical retropubic prostatectomy is a viable treatment option. Practicing adult urologists will need to be aware of this patient population, because they will be seeking out care for common urologic issues as they age. Special considerations of the diagnosis, management, and treatment of prostate cancer in this patient population are discussed.