Radical Cystoprostatectomy Research Articles

The prognostic impact of incidental prostate cancer following radical cystoprostatectomy: a nationwide analysis

Background: To determine the prevalence and prognostic impact of incidental prostate cancer in patients undergoing radical cystoprostatectomy.Methods: A nationwide population-based study of incidental prostate cancer diagnosed following radical cystoprostatectomy. Information on vital status, Gleason score, positive and negative tumor margins, pT-category and subsequent prostate cancer therapies were obtained from the Danish Prostate Cancer Registry and by manual chart review.Results: A total of 1,450 men who underwent radical cystoprostatectomy in Denmark from 1995–2011 were identified. Forty-six men were excluded from analysis, thus 1,404 patients were eligible. The median follow-up was 7.8 years. A total of 466 (33.2%) had incidental prostate cancer diagnosed. No statistical differences in 10- and 15-year cumulative overall mortality were observed when comparing men with, or without, incidental prostate cancer. In men diagnosed with incidental prostate cancer, neither Gleason score, positive surgical margins or locally advanced prostate cancer (pT3–4) was associated with mortality. Only 0.9% received post-operative prostate cancer-related treatment.Conclusion: In this population-based cohort of patients with incidental prostate cancer diagnosed at radical cystoprostatectomy, we found no impact of incidental prostate cancer on overall mortality, regardless of Gleason score, surgical margin status and pathological T-category. Patients diagnosed with incidental prostate cancer following radical cystoprostatectomy are unlikely to benefit from additional follow-up.

Long-Term Safety of Tedizolid in a Patient With Spondilodiscitis After Switch From Linezolid Due to Toxicity

Abstract The patient is a 57-year-old man with liver cirrhosis, Bricker anastomosis after a radical cystoprostatectomy and, a history of bacteremias caused by extended-spectrum β-lactamase–positive Escherichia coli, Enterococcus faecium, and Candida albicans. He presented with persistent low back pain and was diagnosed with vertebral osteomyelitis, for which he received ertapenem-linezolid treatment. However, after 20 days, linezolid had to be discontinued because of myelotoxicity and metabolic acidosis. The patient was switched to tedizolid, which, in combination with ertapenem, was successfully given for 114 days until biopsy showed no growth of gram-positive cocci. We conclude that tedizolid can be an alternative to linezolid in case of toxicity, especially in long-term treatments.

Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial.

To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). Mean age was 53.2 ± 6.5years. Mean ± SD follow-up period was 21 ± 8months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.

Sonic hedgehog regulation of human rhabdosphincter muscle:Potential implications for treatment of stress urinary incontinence.

Rhabdosphincter (RS) muscle injury occurs during prostatectomy, and is a leading cause of stress urinary incontinence (SUI). Current SUI treatments engender significant side effects, which negatively impact patient quality of life. Thus an unmet need exists to develop novel RS regeneration methods. We have shown that Sonic hedgehog (SHH) is a critical regulator of penile smooth muscle, and we have developed novel peptide amphiphile nanofiber hydrogel delivery of SHH protein to the penis to regenerate smooth muscle after prostatectomy induced injury. If similar SHH signaling mechanisms regulate RS muscle homeostasis, this innovative technology may be adapted for RS regeneration post-prostatectomy. We examine the SHH pathway in human RS muscle. Human RS obtained during radical cystoprostatectomy (n = 13), underwent SHH pathway analysis. Primary cultures were established (n = 5), and RS cells were treated with SHH protein, SHH inhibitor, or PBS (control). Immunohistochemical analysis for SHH pathway, skeletal muscle actin, and trichrome stain were performed. RS growth was quantified at 3 and 6 days. SHH, it is receptors patched and smoothened, and transcriptional activators, GLI proteins, were identified in human RS muscle. At 3 and 6 days, RS cells increased 62% and 78% (P = 0.0001) with SHH treatment and decreased 40% (P = 0.0001) and 18% (P = 0.039) with SHH inhibition. The SHH pathway was identified in human RS. RS growth increased with SHH treatment, indicating intervention may be possible to enhance RS regeneration, and impact SUI. Peptide amphiphile delivery of SHH may be applicable for RS regeneration and SUI prevention.

The significance of palliative surgery in castration-resistant prostate cancer

If prostate cancer recurs after primary treatment, deprivation therapy with LHRH analogues or antagonists is the treatment of choice in men with metastatic prostate cancer. However, this treatment only achieves palliative results. Median time to progression ranges between 11 and 78 months. After the introduction of Docetaxel as a first-line treatment in castration-resistant prostate cancer (CRPCA) and cabazitaxel as a second-line chemotherapy, several new drugs containing abiraterone, enzalutamide, radium 223 and sipuleucel-T have become available, which can lead to complete or partial remissions in metastasis, but do not have an effect on the prostate itself as has been shown recently. As a result of local progression of CRPCA, local complications of the urinary tract such as subvesical obstruction, recurrent gross haematuria with or without clotting, upper urinary tract dilatation, rectourethral or rectovesical fistulae and rectal obstruction will occur in about one third of all patients. Several surgical treatment options are available to manage the aforementioned complications. In patients with local progressive CRPCA and lower urinary tract symptoms, palliative TUR-P, radical prostatectomy or radical cystoprostatectomy with urinary diversion and even anterior and posterior exenteration can be performed in selected patients, requiring a preoperative multiparametric MRI of the prostate and the pelvic floor along with a laboratory examination to optimise surgical techniques and perioperative outcomes. In case of symptomatic involvement of the upper urinary tract system, the placement of endoluminal DJ stents or percutaneous nephrostomy in men with a poor performance status and a short life expectancy is the treatment of choice. In men with an ECOG performance status of 0 to 1, reconstructive surgery such as ureteral reimplantation, ileal ureteral replacement or placement of a subcutaneous pyelovesical bypass is an appropriate treatment option. To summarise, the aforementioned palliative surgical treatment options should be provided for selected patients and performed by well-experienced urologists.

Transperineal Approach for Intracorporeal Ileal Conduit Urinary Diversion Using a Purpose-built Single-port Robotic System: Step-by-step

To describe a step-by-step technique for single-port transperineal intracorporeal ileal conduit urinary diversion using a purpose-built robotic platform. In one male cadaver, the da Vinci SP1098 surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform intracorporeal ileal conduit urinary diversion by a transperineal approach after radical cystoprostatectomy and bilateral pelvic lymph node dissection. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12-mm × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments, and a 6-mm accessory laparoscopic instrument were placed. Moreover, at the planned level of the cutaneostomy, a 12-mm port to accommodate the Endo-GIA was placed. The primary outcomes were the technical feasibility, the operative time, and the record of eventual procedural complications. The intervention was successfully completed without any conversion or need for additional ports. The total operative time was 200 minutes. Operative time for urinary diversion was 90 minutes. We demonstrated the feasibility of single-port transperineal intracorporeal ileal conduit urinary diversion using the SP1098 purpose-built robotic platform. Limitations include the preclinical setting. The applicability in the clinical model is awaited to be tested after the platform will be commercially available.

647 An outcomes analysis of 47 penile prosthesis implantations after cistoprostatectomy for muscle-invasive bladder cancer: a multicentric study

To report the outcomes of a multicentric series of patients underwent a penile prosthesis (PP) implantation following radical cystoprostatectomy (RCP). A multicentric database, involving 4 tertiary referral centers, was created. From December 2004 to September 2017 65 patients underwent a PP implantation for a medically refractory ED following a RCP for bladder cancer. Clinical records were retrospectively reviewed. 47 patients, presenting comprehensive intraoperative and postoperative information were enrolled in the study. Patients were confined in 2 groups according to the type of urinary diversion: neobladder (A) or other diversions (B), including ileal conduit and ureterocutaneostomy. The intraoperative complications, the hospital stay, a postoperative haematoma scale and the postoperative complications were selected as variables for the surgical outcomes. 14 patients (29.8%) were enrolled in group A, whereas the remainders were in group B. A consistent percentage (65.9%) of patients were referred to an early postoperative sexual counseling, with a median time of 12 months after surgery. Most of the patients (65.9%) started pde-5 inhibitors as a first line treatment and less than half of the them (44.7%) used a second line attempt, intracavernous injections (ICI). Overall, the time elapsed between the RCP and the PP implant was long, with a median of 38 months. Nevertheless, the median implant length resulted to be satisfactory (19 cm) and the need of a reduced diameter cylinder (CXR®) was a rare event. Despite the previous pelvic surgery, most of the PP implanted were three-pieces. The spherical reservoir was the most used, compared to the low-profile (Conceal®). In most of the cases a safe placement of the reservoir in the extraperitoneal space through a second abdominal incision was the preferred surgeon’s choice. However, the ectopic high-submuscolar placement was used in up to 30% of cases in group A. Both intraoperative and postoperative complications resulted to be rare events. Finally, the multivariate statistical analysis did not show any independent predictive risk factor for postoperative complications.

Prostate sparing cystectomy for bladder cancer: A two-center study

PurposeTo assess long-term functional and oncologic outcomes of prostate sparing cystectomy (PSC) as a sexuality-preserving alternative to radical cystectomy in a selected group of bladder cancer (BC) patients. Materials and methodsBetween 1995 and 2014, 185 BC patients underwent PSC according to one of two standardized procedures at two centers. All patients had received extensive evaluation to rule out prostate cancer and BC at the bladder neck and prostatic urethra (PU), including prostate specific antigen blood analysis, transrectal ultrasound and/or prostate biopsies, PU biopsies and/or PU frozen section analysis. All patients received an orthotopic ileal neobladder. Overall survival (OS) was assessed by Kaplan–Meier estimates. Cumulative incidence of cancer specific mortality, any recurrence and loco-regional recurrence were calculated using competing-risk methods. Finally, functional outcomes (voiding, continence and erectile function) were evaluated. Results185 patients (cTa-3N0M0) with a mean age of 57 years (SD: 9) were included. Median follow-up was 7.5 years (IQR: 5.6–10.8). Five-year OS was 71% and 5-year cumulative incidence of recurrence was 31%. Twenty patients (10.8%) had a loco-regional recurrence, two recurrences were in the PU. During follow-up, prostate cancer was detected in six patients (3.2%). Erectile function was preserved in 86.1% of patients, complete daytime and nighttime continence in 95.6% and 70.2%, respectively. ConclusionThis two-center study shows that in men with BC in whom the prostate and PU were proven free of malignancy, PSC would represent a valid treatment option with excellent functional outcome. Oncologic outcomes were comparable to what is known from radical cystoprostatectomy series.

PD43-02 EVALUATION OF URINARY CONTINENCE FOLLOWING NERVE SPARING OPEN RADICAL CYSTOPROSTATECTOMY AND ORTHOTOPIC URINARY DIVERSION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-02 EVALUATION OF URINARY CONTINENCE FOLLOWING NERVE SPARING OPEN RADICAL CYSTOPROSTATECTOMY AND ORTHOTOPIC URINARY DIVERSION Zhoobin Bateni, Ankeet Shah, Soroush Bazargani, Kevin Wayne, Gus Miranda, Jie Cai, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Zhoobin BateniZhoobin Bateni More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Kevin WayneKevin Wayne More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been suggested that nerve-sparing (NS) techniques can improve urinary continence following radical prostatectomy but there is lack of strong evidence in the literature about the effect of NS techniques on urinary continence following radical cystoprostatectomy (RCP). We evaluated urinary continence in male patients undergoing ONB diversion following NS versus non-NS RCP using a validated pad usage questionnaires. METHODS Beginning in 2012, we started to use an IRB approved, validated, pictorial pad usage questionnaire assessing the number, size, and wetness of pads at each follow-up visits of patients with ONB. We found 253 male patients which had filled out pad usage questionnaires at least one time. The time of the RCP was from 2002 to 2017. Continence was defined as no pad usage or pads as almost dry. We evaluated whether a nerve-sparing approach had any impact on continence. RESULTS The median age of 67 years and median BMI of 27.3 kg/m2. The median follow-up was 729 days. There was no significant difference between pathologic stage, adjuvant or neoadjuvant therapies, BMI, diabetes, history of smoking and perioperative care/catheter management of the two groups. There was a significantly shorter median time to daytime continence in the NS group compared to non-NS group (133 days vs 216 days; p=0.01). Kaplan-Meier curves showed significantly higher daytime continence rates in NS group at one year compared to non-NS ones (63% +/- 5% vs. 54% +/- 4%; p=0.002). A similar pattern was observed for one-year nighttime continence rates between the groups (43% +/- 5% in NS vs. 35% +/- 4% in non-NS; p=0.011) (figure 1). After controlling for potentially confounding factors including age, BMI, diabetes, comorbidities, smoking, pathological stage, pelvic floor muscle training, operative time, and blood loss, multivariate Cox regression model revealed that patients in NS group, were 1.6 times more likely to gain daytime continence by one year (OR:1.6 [95%CI, 1.2-2.2]; p=0.003). CONCLUSIONS Men with ONB following NS RCP have faster return to daytime and nighttime continence in the first year compared to the non-NS ones. Further research with randomization and a larger sample size is needed to rule out confounding factors to support the value of doing NS surgery on continence after RCP and ONB. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e877 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zhoobin Bateni More articles by this author Ankeet Shah More articles by this author Soroush Bazargani More articles by this author Kevin Wayne More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A modified cutaneous ureterostomy provides satisfactory short and midterm outcomes in select cases.

We present the outcomes of modification of cutaneous ureterostomy by extreme lateralization of the stoma and use of skin flap for formation of ureterostomy. Between June 2012 and June 2016, 36 patients had modified cutaneous ureterostomy for ureteral obstruction due to pelvic malignancy or genitourinary tuberculosis. Transureteroureterostomy was made with cutaneous stoma at anterior axillary line between iliac crest and lower rib cage, instead of spinoumbilical line. To prevent stenosis a 'V' shaped skin was fed into the stoma. Double J stents were used in all patients for 6 weeks. Perioperative morbidity and mortality were evaluated. All patients were followed up at 3 month intervals. Of 36 patients, 22 had radical cystoprostatectomy (including nephroureterectomy in 2 patients) and 7 had palliative cystectomy. Others had locally advanced prostate cancer (n=1), locally advanced cervical cancer (n=3), ovarian cancer (n=1) and genitourinary tuberculosis with small capacity bladder along with a large vesicovaginal fistula (n=1). One patient developed ureteral necrosis requiring conversion to ileal conduit. Three patients developed stomal stenosis: two were managed by self-dilatation while one required revision of stoma. Thirteen patients died of the disease at a median follow up of 6 months with functioning stoma. Remaining 19 patients survived without any complications at a median follow-up of 20.5 months (5.5-43.5 months). None of the patients had any problem related to ureterostomy bag application. Modified lateral cutaneous ureterostomy provides relatively straighter and shorter retroperitoneal course of ureter with acceptable morbidity and avoids use of bowel in selected patients.

823 - Radical cystoprostatectomy in high risk prostate cancer. Is it worth it?

823 - Radical cystoprostatectomy in high risk prostate cancer. Is it worth it?

Perioperative hypogonadism in men undergoing radical cystoprostatectomy for bladder cancer.

470 Background: Radical cystectomy (RC) is associated with significant morbidity, and loss of body weight is a common after RC, even in patients without significant nutritional deficiencies. Prior studies have demonstrated a high prevalence of hypogonadism (HG) in men with cancer and who undergo anesthesia/major surgery. The suppression of testosterone persists up to seven days following surgery. We hypothesize that hypogonadism is prevalent in male patients undergoing RC for bladder cancer (BC), and that it persists in the post-operative period. Methods: We implemented a prospective, IRB-approved trial (Clinical trials.gov # NCT03063125) to prospectively enroll 25 men with no prior history of treatment for HG or other hormonal disorders with a new diagnosis of non-metastatic bladder cancer undergoing RC. Pre-operative total, free testosterone and luteinizing hormone (LH) were obtained. These labs were then repeated on post-operative days 2, 3, 30, and 90. The threshold for normal total testosterone was defined as &gt; 250 ng/dl. Demographic data were recorded. Results: Between March and September 2017, 9 patients have been enrolled into the study. Mean patient age is 68.5 years (52-85). The mean pre-operative total testosterone was 247 ng/dl (range 50-496 ng/dl) and 6/9 (66.7%) patients had HG. Two patients had abnormal pre-operative LH levels (range 21-57 mIU/L). Testosterone decreased by a mean of 99 ng/dl between pre-op assessment and post-operative day 2 [95% CI 66.2, 131.8]; all 6 men who initially had HG remained below 250 ng/dl. Two men moved from eugonadal (347 ng/dl, 316 ng/dl) to hypogonadal (213 ng/dl,192 ng/dl, respectively) by post-operative day 2. At 30 days post-op, the mean T level was 206 ng/dl. No patients had returned to levels at or above their pre-operative baseline and 8/9 (88.9%) had HG (range 40-356 ng/dl). Conclusions: Hypogonadism is prevalent in men undergoing RC; our trial demonstrates a pre- and 30 day post-operative prevalence of 66.7% and 88.9%%. Furthermore, HG persisted beyond the immediate post-operative period. Treatment of peri-operative HG with correction to a eugonadal state may represent a therapeutic intervention to reduce the morbidity associated with radical cystectomy. Clinical trial information: NCT03063125.

3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes

BackgroundAfter radical cystoprostatectomy (RC), postoperative erectile dysfunction (ED) is a common consequence with multiple contributing etiologies. The inflatable penile prosthesis (IPP) offers patients a definitive treatment option when ED is refractory to medical therapies. Because of the hostile postoperative anatomy of these patients, a careful surgical approach is necessary for successful outcomes and to avoid adjacent organ injury. To date, there is no series describing the outcomes of 3-piece IPP placement in patients with urinary diversions. AimTo present contemporary outcomes and a description of our technique in placing a 3-piece IPP for postoperative ED in patients with a history of RC with orthotopic neobladder, ileal conduit, or continent cutaneous diversion. MethodsWe retrospectively reviewed 80 patients who underwent primary placement of a 3-piece IPP (AMS 700; American Medical Systems Inc, Minnetonka, MN, USA) after RC and urinary diversion from 2003 through 2016. 79 patients underwent RC in their treatment of urologic malignancy (71 for bladder cancer, 8 for prostate cancer) and 1 underwent RC for refractory interstitial cystitis. An infrapubic approach was used in most patients, with reservoir placement in the lateral retroperitoneal space through a counterincision medial to the anterior superior iliac spine. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. OutcomesRates of device infection, revision surgery, and reservoir complications. ResultsAfter mean follow-up of 53.9 months (6.5–150.7 months), 4 patients developed infection of the prosthesis that required explantation. 3 of those patients underwent successful IPP reimplantation. 5 patients required revision surgery (pump replacement, n = 3; pump relocation, n = 1; cylinder replacement for cylinder aneurysm, n = 1) for mechanical failure. No statistically significant associations were found between infection and comorbidities, urinary diversion, exposure to chemotherapy, radiation, or presence of an artificial urinary sphincter. Clinical ImplicationsThe 3-piece IPP is an effective treatment option for medication-refractory ED that can be placed safely in patients with all forms of urinary diversion. Strengths and LimitationsThis study represents the 1st series that describes a successful technique and long-term outcomes of patients with urinary diversion. It is limited by its single-surgeon, single-center experience and lacks validated patient satisfaction data in follow-up. ConclusionsThe 3-piece IPP, with reservoir placement in the lateral retroperitoneum, can be implanted successfully in patients with all forms of urinary diversion without a significant increase in infectious complications, reservoir erosion, or mechanical failure.Loh-Doyle J, Patil MB, Sawkar H, et al. 3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes. J Sex Med 2018;15:907–913.

Two cases of plasmacytoid variant of bladder cancer

Introduction: Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive variant of bladder cancer. Since PUC is infrequently encountered, its management continues to be a formidable challenge.&#x0D; Case 1: A 74-year-old gentleman was admitted with a 1-month history of gross hematuria and urinary overflow incontinence. Cystoscopy revealed an abnormal growth at the bladder base and biopsies were taken. This patient had high grade PUC sparing the muscularis propria (MP). He underwent nephrostomy tube insertion and subsequent conversion to internal stents 8 weeks later. Repeat resection showed muscle-invasive PUC. Repeat CT showed subcentimeter bilateral inguinal and external iliac lymphadenopathy. The surgeon discovered a dense infiltrative reaction within the retroperitoneum and colonic obstruction during radical cystoprostatectomy and palliative colostomy, confirming metastatic PUC.&#x0D; Case 2: A 72-year-old gentleman presented with gross hematuria, bleeding from an established end ileostomy, and bowel obstruction symptoms. Cystoscopy identified an anterior bladder tumour and CT staging confirmed a small bowel obstruction (SBO). Transurethral resection showed PUC with invasion of the MP and lymphovascular space. Obvious positive margins were identified during radical cystoprostatectomy, as the tumour clearly invaded bone and the rectal stump. Ileostomy output ceased post-operatively on day 4, and bowel contents began leaking through his urethra the following day. Reassessment of goals of care resulted in cessation of significant interventions. Unfortunately, he passed away 2 weeks post-operatively due to sepsis.&#x0D; Discussion: These cases illustrate the aggressiveness of PUC bladder tumours and how imaging frequently under-stages these patients. Neoadjuvant chemotherapy prior to attempting surgical control may be beneficial.

Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center.

ABSTRACTPurposeTo investigate the incidence and pathologic characteristics of prostate cancer (PCa) incidentally discovered at the time of radical cystectomy and its impact on overall survival.Materials and MethodsA single center retrospective study of 762 male patients who underwent radical cystoprostatectomy from Jan 1994 to Dec 2012.ResultsOf all included patients, 132 (17.3%) were found to have PCa. Patients with incidental PCa had a significantly higher mean age (69.2 vs. 62.2 years, P=0.015). Among the 132 patients with PCa, prostate specific antigen (PSA) analysis was available in 76 patients (57.6%), with a median value of 1.06ng/mL, and 61 (80.3%) patients had a PSA value below 4ng/mL. Four hundred and thirty-six patients (57.1%) were successfully followed, with a median duration of 46.5 months. The overall 5-year survival rate was 62.1%, and the 5-year cancer–specific survival rate was 72%. PCa recurrence was defined by two consecutive PSA values of >0.2 ng/mL and rising, and no PCa recurrence occurred. According to a univariate analyses, incidental PCa was not associated with cancer-specific survival (P=0.192) or overall survival (P=0.493). According to univariate analyses, the overall survival of patients with PCa was not associated with prostate cancer staging, PSA value, or Gleason score (All P values>0.05).ConclusionsProstate cancer incidentally discovered at the time of radical cystectomy does not decrease overall survival. Patients with incidental PCa were older than those without. The PSA value before operation is not helpful for predicting incidental prostate cancers.

Does preoperative neutrophil/lymphocyte rate have an effect on survival of the bladder cancer patients who received radical cystectomy?

Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC. Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software. Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patients. Multivariate analysis showed age, lymph node metastasis, and low N/L rate as significant in cancer-specific survival. In our study, age, lymph node metastasis presence, and preoperative low N/L rates were detected as independent risk factors in RC cases. N/L rate, which is relatively easy to assess during preoperative period, could be beneficial in planning postoperative adjuvant treatments in those patients.

Prevalence and Pathological Analysis of Adenocarcinoma Prostate Discovered Incidentally in Radical Cystoprostatectomy Specimen: An Indian Center Experience

Prevalence and Pathological Analysis of Adenocarcinoma Prostate Discovered Incidentally in Radical Cystoprostatectomy Specimen: An Indian Center Experience

Long-term postoperative results of the hautmann ileal orthotopic neobladder reconstruction after radical cystoprostatectomy of bladder cancer

Long-term postoperative results of the hautmann ileal orthotopic neobladder reconstruction after radical cystoprostatectomy of bladder cancer

Prevalence and clonality of synchronous primary carcinomas in the bladder and prostate

Incidental prostate adenocarcinoma (IPCa) has been frequently discovered during postoperative histopathological evaluation of radical cystoprostatectomy specimens in patients with bladder cancer (BCa). However, there is currently no conclusive study addressing the clinical significance of IPCa and the clonal relatedness of IPCa and BCa. Here, we performed a retrospective single-center review of 919 BCa cases and an additional meta-analysis including a total of 19 868 individuals who underwent radical cystectomy for bladder cancer. IPCa, mostly clinically insignificant, was detected in 67 of 919 BCa patients (7.3%) and was significantly associated with greater age. In the meta-analysis, a lower prevalence was observed in Asian than in non-Asian countries (19% versus 32%), presumably due to their different rates of prostate cancer occurrence. Whole-exome sequencing on matched BCa and IPCa samples unambiguously revealed independent clonal origins of the synchronous tumors. BCa and IPCa lesions from each patient displayed distinctive genomic abnormalities and largely unrelated mutational signatures of single nucleotide variations, indicating disparate mutational processes underlying bladder and prostate oncogenesis. These findings provide important insights into the incidental nature of prostate adenocarcinoma in patients with bladder cancer, and suggest that the two concurrent diseases can be managed separately. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

When Chemotherapy Is Not Enough—Management of Prostatic Embryonal Rhabdomyosarcoma in an Infant

A baby boy was diagnosed with embryonal rhabdomyosarcoma causing left hydroureteronephrosis. A loop ureterostomy was performed, and the infant was treated per the RMS13 protocol. After 3 months of chemotherapy, the infant's tumor burden increased, and he underwent radical cystoprostatectomy and right-to-left transureteroureterostomy (end-to-end fashion utilizing the distal limb of his ureterostomy). This innovative method was utilized because the infant's tumor burden was too large to be treated effectively and safely with radiation. One year later, the infant has no evidence of disease. This demonstrates that optimal management of rhabdomyosarcoma is still unknown; therefore, each child warrants an individualized approach for optimal outcomes.