Robotic Radical Cystectomy Outcomes after Intervention for Prostate Cancer.

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Prostate cancer treatment often precedes bladder cancer diagnosis.
• Robot-assisted radical cystectomy (RARC) is a treatment option for bladder cancer.
• Outcomes of RARC following prior prostate cancer interventions require detailed evaluation.

Purpose of the Study:

• To assess clinical, pathologic, and survival outcomes in patients undergoing RARC after prior prostate cancer treatment.
• To compare outcomes of RARC in patients with prior radical prostatectomy (RP) or radiation therapy (XRT) versus those without prior prostate cancer history (radical cystectomy [RC]).

Main Methods:

• Retrospective analysis of 333 male patients undergoing RARC with urinary diversion (2009-2019).
• Patients were categorized into three groups: prior RP, prior XRT, and no prior prostate cancer intervention (RC).
• Comparison of demographic, operative, pathologic, and survival data across the three groups.

Main Results:

• Patients in RP and XRT groups were older with higher comorbidity scores than the RC group.
• The RP group showed a significantly higher rate of positive surgical margins (31.58%) compared to RC (8.22%) and XRT (10.00%).
• The XRT group exhibited a higher rate of extravesical disease (60.00%) and the lowest overall survival compared to RC (37.5%) and RP (36.85%).

Conclusions:

• Prior radical prostatectomy is associated with increased positive margin rates in RARC.
• Prior radiation therapy is linked to higher rates of extravesical disease and reduced overall survival post-RARC.
• Careful patient counseling regarding these specific risks is essential for individuals undergoing RARC after prostate cancer treatment.