Prostate sparing cystectomy for bladder cancer: 20-year single center experience

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Bladder cancer treatment often involves radical cystectomy, which can lead to significant morbidity.
• Prostate-sparing cystectomy (PSC) is an alternative approach for select patients, aiming to preserve function.
• Long-term oncologic and functional outcomes of PSC require thorough evaluation.

Purpose of the Study:

• To evaluate the long-term oncologic safety and functional results of prostate sparing cystectomy for bladder cancer.
• To assess disease-specific survival, recurrence-free survival, and recurrence rates after PSC.
• To analyze functional outcomes including continence, voiding, and sexual function post-PSC.

Main Methods:

• A cohort of 120 patients with cT1-4N0-3 bladder cancer underwent PSC between 1994 and 2013.
• Preoperative evaluations included biopsies of the bladder neck and prostatic urethra, PSA measurement, and transrectal ultrasound to exclude malignancy.
• Oncologic outcomes (survival, recurrence) and functional outcomes (continence, sexual function) were assessed in 110 patients with at least 2 years of follow-up.

Main Results:

• Two and 5-year disease-specific survival rates were 76.2% and 66.5%, respectively.
• Two and 5-year recurrence-free survival rates were 71.2% and 66.6%, respectively; local recurrence occurred in 10.0% of cases.
• Excellent functional outcomes were observed: 96.2% daytime continence, 81.9% nighttime continence, 89.7% preserved erectile function, and 35.5% antegrade ejaculation.

Conclusions:

• Prostate sparing cystectomy is an oncologically safe procedure for carefully selected bladder cancer patients.
• The study demonstrates excellent long-term functional outcomes, including high rates of continence and preserved sexual function.
• PSC is a viable option for patients without urothelial carcinoma in the prostatic urethra/bladder neck and no concurrent prostate cancer.