Transurethral prostate biopsy before radical cystectomy remains clinically relevant for decision-making on urethrectomy in patients with bladder cancer

Abstract

This study retrospectively evaluated the clinical relevance of transurethral prostate biopsy (TUPB) before radical cystectomy by comparing the pathology of prostatic urethra biopsy specimens with that of cystectomy specimens. Of 294 patients who underwent cystectomy and urinary diversion, 101 men with preoperative TUPB were included in this study. For these patients, if the result of TUPB was positive for urothelial carcinoma, we performed urethrectomy as a rule. If it was negative, we presented the option of urethral preservation and decided the final type of urinary reconstruction. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of TUPB were assessed, and we investigated the number of final urethral recurrences. We also tried to identify which clinical and pathological findings by TUPB most accurately predicted the disease remaining in the prostate of cystectomy specimens. Of the 25 patients with positive TUPB, 18 had disease in the prostatic urethra or stroma of cystectomy specimens. There were 3 patients with negative TUPB but with involvement of the prostate in cystectomy specimens. Thus, TUPB achieved 86% sensitivity, 91% specificity, 72% PPV, and 96% NPV. Two patients (1.9%) had urethral recurrence in this period. Among the findings for TUPB, non-papillary tumors most accurately predicted the disease in the prostate of cystectomy specimens. TUPB achieved a high NPV and the urethral recurrence rate was acceptable. If TUPB was negative, patients could have chance urethral preservation. Thus, our clinical decision for urethrectomy based on the result of TUPB is still useful.