The role of cystoscopy before radical prostatectomy

Abstract

To determine the role of pre-operative cystoscopy in men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate. One hundred men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate were evaluated for coexisting bladder pathology from a retrospective review of their charts and records. Four of 100 men undergoing radical prostatectomy for clinically localized prostate cancer were found to have synchronous bladder tumours. Two of these had superficial low-grade transitional cell carcinoma (TCC), one had a poorly differentiated invasive TCC and the last was found to have an inverted papilloma during radical retropubic prostatectomy. The patient with invasive disease died before the initiation of definitive therapy. The other three men are free of disease 2 years after diagnosis and treatment. Because of the low cost and minimal morbidity of pre-operative flexible cystoscopy, we recommend that this procedure be performed on the operating table before prostatectomy. In patients with gross or microscopic haematuria, a significant history of smoking, a prior history of urothelial malignancy or symptoms of bladder outlet obstruction, cystoscopy would be best performed before surgery in an out-patient setting.