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Concomitant pathology in the prostate in cystoprostatectomy specimens: a prospective study and review
Mohamed Saad1, Mona Abdel-Rahim, Hassan Abol-Enein
1Department of Urology, Urology and Nephrology Centre, Mansoura, Egypt.
Objectives:
To investigate possible associated pathology in the prostate removed from patients with invasive bladder cancer and determine if there is a justification for prostate-sparing cystectomy.
Patients And Methods:
Between March 2005 and July 2007, 425 men (mean age 59 years, sd 8.23) had a cystoprostatectomy at our institute. The prostate was step sectioned at 2-3 mm intervals and any associated pathology determined; patient and tumour characteristics were correlated with prostatic pathology. The results were compared with those published previously, and the potential functional advantages of prostate sparing are reviewed and discussed.
Results:
Prostatic adenocarcinoma was detected in 90 of the 425 (21.2%) patients. There was no significant correlation between preoperative prostate-specific antigen level and the presence of adenocarcinoma, Gleason score or prostatic tumour stage. There was prostatic involvement as a result of direct invasion by the primary bladder tumour (contiguous) in 39 cases (9.2%). Concomitant (non-contiguous) transitional cell carcinoma of the prostatic urethra and/or ducts was detected in 27 specimens (6.4%). Additional findings were high-grade prostatic intraepithelial neoplasia in 43 patients (10.1%) and benign prostatic hyperplasia in 175 (41.2%).
Conclusion:
We think that the potential oncological risks of prostate-sparing cystectomy outweigh any small and possible functional benefits; accordingly, the prostate should not be retained.
