Radical Cystoprostatectomy For Bladder Cancer Research Articles

Intraprostatic hormone dosage: Validation of a novel prostate biopsy technique

BackgroundAdvances in chromatography and mass spectrometry have allowed us to develop a novel technique for measuring intraprostatic hormone concentrations directly on prostate needle biopsies, rather than using traditional punch excision. This has significant clinical implications as intraprostatic dihydrotestosterone and testosterone levels could help monitor prostate growth, neoplasia and castration resistance. MethodsPatients undergoing radical cystoprostatectomy for bladder cancer were prospectively included. Each prostate specimen received one 90mg punch excision and six needle biopsies. Intraprostatic hormones were dosed through gas chromatography-mass spectrometry. ResultsWe included twenty patients, of which eleven were incidentally diagnosed with prostate cancer; four had ISUP 1 (20%) and seven had ISUP 2 (35%). The prostate biopsy technique was unable to obtain measures for testosterone, Delta-4-androsterone and androstenedione. Tissue concentrations of DHEA, DHT, E1 and E2 can be obtained with no significant difference from the reference established on a punch from a single biopsy core sample. ConclusionsOur study demonstrates that intraprostatic concentrations of DHEA, DHT, E1 and E2 can be measured without significant difference from the reference established on a single punch excision. This finding opens the way to research on the interactions between endocrinology and prostate oncogenesis and particularly on the mechanisms of resistance to hormone therapies in vivo. Level of evidence2

Prostate Cancer among Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer in the Department of Urology in a Tertiary Care Centre.

Prostate cancer is the most common malignancy in men and remains one of the most prevalent and least understood of all human malignancies. Bladder cancer is the most frequently diagnosed cancer in China. Radical cystectomy remains the gold standard for muscle-invasive, recurrent and multiple bladder cancer. All male patients undergoing radical cystoprostatectomy must be evaluated for prostate cancer before planning surgery. The aim of this study was to find out the prevalence of prostate cancer among patients undergoing radical cystoprostatectomy undergoing surgery for bladder cancer. A descriptive cross-sectional study was conducted in a tertiary care centre from 1 August 2023 to 30 August 2023 where data from 1 January 2015 to 30 December 2017 was taken from medical records after obtaining ethical approval from the Ethical Review Board. All patients who underwent radical cystoprostatectomy were included in the study. Whole radical cystoprostatectomy specimens were cut transversely at 3 mm intervals and examined in the same pathological centre. Clinically significant prostate cancer was defined as a tumour with a Gleason pattern ≥4, prostate tumour with clinical stage ≥pT3, lymph node. involvement, positive surgical margin or multifocality of three or more lesions. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 210 patients, 52 (24.76%) (18.92-30.60, 95% Confidence Interval) had incidental prostate cancer. The average age of patients with incidental prostate cancer was 65.88±9.54 years. The prevalence of incidental prostate cancer was found to be lower than the study conducted in a similar setting. bladder cancer; incidental findings; prostate cancer.

Penile Prosthesis Utilization After Radical Cystoprostatectomy for Bladder Cancer

ABSTRACT Introduction Radical cystoprostatectomy for bladder cancer may adversely affects sexual function in up to 80% of men. Penile prosthesis implantation can restore erectile function in these men, but the extent to which penile prosthesis is utilized in this patient population is unknown. Objective We aimed to determine the rate of and time to penile prosthesis implantation for men who have previously undergone radical cystectomy for bladder cancer. Methods Using the Premier Healthcare Database, we investigated all male patients undergoing radical cystectomy between 2000 and 2020 and identified the subgroup of patients undergoing penile prosthesis implantation. We compared sociodemographic characteristics in men who did and did not undergo implantation. Categorical variables were analyzed with Chi-squared tests and continuous variables were analyzed with Kolmogorov-Smirnov tests. Results We identified 142 men who underwent cystoprostatectomy and subsequently underwent penile prosthesis implantation. Among these 142 patients, 16 (11.27%) had a penile prosthesis placed on the day of cystectomy and 106 (74.65%) had a subsequent penile prosthesis placed at a median of 503.5 days (IQR 214-821 days) following cystectomy. Patients who underwent penile implant were statistically younger (64 years vs 68 years, p<0.001) and more likely to have private insurance (39% vs 25%, p<0.001), as compared to patients who did not have a follow up for penile prosthesis. Conclusions Sexual function is an important aspect of cancer survivorship and treatment of post-cystectomy erectile dysfunction should be considered a critical component of care. When penile prosthetics were utilized, this occurred with significant delay (median 503.5 days). Efforts to increase education about available treatment options, inclusion of sexual medicine urologists in post-cystectomy care pathways, and decreasing time to penile implantation may all improve quality of life for bladder cancer survivors. Disclosure No

Oncologic impact of concomitant prostate cancer characteristics at the time of radical cystoprostatectomy for bladder cancer: a population-based analysis

Objective The aim of this study was to evaluate the prognostic impact of concomitant prostate cancer (PCa) of the cancer-specific mortality (CSM) in the aging patient’s papulation with bladder cancer (BCa) treated with radical cystoprostatectomy (RCP). Materials and Methods Within the SEER database (2004–2015), 1468 patients were treated with RCP for BCa harboring histopathological PCa findings. To account for other cause mortality (OCM), multivariable competing risk regression (CRR) tested for potential BCa-CSM differences according to PCa characteristics risk factors predicting CSM Results CRR analysis revealed that only following BCa characteristics, as high pathological tumor stages(Ta/Tis/T1 [REF.] vs. T2; HR 2.03, 95% CI: 1.16-3.57, p = 0.014 vs. T3; HR 4.32, 95% CI: 2.45-7.61, p < 0.001 vs. T4; HR 5.06, 95% CI: 2.77–9.22, p < 0.001), as well unfavorable BCa grade IV (Grade I–II [REF.] vs. Grade IV; HR 0.58, 95% CI: 0.35-0.98, p < 0.041) achieved independent predictor status of CSM. With regard to PCa characteristics, none of the covariates yielded independent predictor status of CSM. Conclusions Our study, based on the largest population cohort, demonstrates that even in organ-confined BCa patients, concomitant PCa as second malignancy does not represent a risk factor for survival.

The Incidental prostatic adenocarcinoma and transitional cell carcinoma involvement of the prostate gland in patients undergoing radical cystoprostatectomy for bladder cancer treatment in Rajavithi Hospital

Objective: To determine the incidence of incidental prostatic adenocarcinoma and transitional cell carcinoma (TCC) involvement of the prostate gland in patients undergoing radical cystoprostatectomy in Rajavithi Hospital, Secondly, to assess the possible influence of the patient factors and bladder cancer on the pathological findings of the prostate gland. Materials and Methods: We retrospectively reviewed 169 male patients who had undergone radical cystoprostatectomy for bladder cancer between April 2013 and August 2019. Pathologic findings of the prostate gland and urothelial cancer in the prostate gland were catalogued. Information including age, body mass index (BMI), underlying disease, glomerular filtration rate (GFR), pathologic stage, and grade was collected and analyzed to determine any correlations. Results: Incidental prostatic adenocarcinoma and TCC involvement of the prostate gland were found in 15 patients (8.9%) and 29 patients (17.2%), respectively. There were no correlations between patient demographics and pathological findings of the prostate gland. Conclusion: Although the incidence of incidental prostatic adenocarcinoma and TCC involvement of the prostate gland in our research is low, the screening of every candidate for prostate sparing cystectomy with a digital rectal examination, prostate-specific antigen, and transurethral biopsy of the prostatic urethra and bladder neck prior to surgery are recommended.

Robot-assisted orthotopic "W" ileal neobladder in male patients: step-by-step video-illustrated technique and preliminary outcomes.

The objectivewasto describe our step-by-step technique for robot-assisted orthotopic "W" ileal neobladder (INB) for urinary diversion following radical cystectomy for oncological purpose, and to report the outcomes of this technique for the first six malepatients treated at our center. Patients underwent robot-assisted radical cystoprostatectomy for bladder cancer and had a "W" ileal neaobladder as urinary diversion. Our surgical technique is described step by step and video illustrated. Patients and operative data were collected and reported. The Expanded Prostate Cancer Index Composite Short Form (EPIC-26) self-administered questionnaire was used to assess the urinary, sexual and bowel functions outcomes at 90days postoperatively. The mean operative time was 475min [420-525] and mean length of stay was 13days [11-15]. No major complications occurred (Clavien grade ≥ 3). Regarding the continence four patients reported they leaked urine rarely or never and two patients having urine leak once a day. Two patients did not wear any pad, the four others reported using pad at night. Two patients reported urinary function as not a problem, one as a very small problem, two as a small problem and one as a moderate problem. These results from our six first cases using the technique described here are promising with interesting early functional outcomes. This has to be confirmed on larger cohort and with long-term follow-up.

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.

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.

Incidentally identified prostate cancer following radical cystoprostatectomy for bladder cancer

Incidentally identified prostate cancer following radical cystoprostatectomy for bladder cancer

Dynamic instrumented palpation – a new method for soft tissue quality assessment: application to prostate disease diagnosis

The objective is to establish the feasibility of using dynamic instrumented palpation, a novel technique of low-frequency mechanical testing, applied here to diagnose soft tissue condition. The technique is applied, in vitro, to samples of excised prostate gland affected by benign prostate hyperplasia and/or prostate cancer. Particular attention is paid to the relationship between the histological structure of the tissue and the dynamic mechanical properties in an attempt to separate patient-specific aspects from histopathological condition (i.e. prostate cancer or benign prostate hyperplasia). The technique is of clinical interest because it is potentially deployable in vivo. Prostate samples were obtained from a total of 36 patients who had undergone transurethral resection of the prostate to relieve prostatic obstruction and 4 patients who had undergone radical cystoprostatectomy for bladder cancer. Specimens (chips) recovered from transurethral resection of the prostate were of nominal size 5 mm × 8 mm and thicknesses between 2 and 4 mm, whereas those from the cystoprostatectomy were in the form of transverse slices of thickness approximately 6 mm. Specimens were mechanically tested by a controlled strain cyclic compression technique, and the resulting dynamic mechanical properties expressed as the amplitude ratio and phase difference between the cyclic stress and cyclic strain. After mechanical testing, the percentage areas of glandular and smooth muscle were measured at each probe point. Good contrast between the dynamic modulus of chips from benign prostate hyperplasia and prostate cancer patients was demonstrated, and absolute values similar to those published by other authors are reported. For the slices, modulus values were considerably higher than for chips, and good in-patient mechanical contrast was revealed for predominantly nodular and predominantly stromal areas. Extending this classification between patients required pattern recognition techniques. Overall, the study has demonstrated that dynamic mechanical properties can potentially be used for diagnosis of prostate condition using in vivo measurements.

MP54-19 IMPACT OF PROSTATE INVOLVEMENT ON OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2017MP54-19 IMPACT OF PROSTATE INVOLVEMENT ON OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER Marco Moschini, Andrea Gallina, Giusy Burgio, Paolo Dell'Oglio, Emanuele Zaffuto, Agostino Mattei, Rocco Damiano, Shahrokh Shariat, Vincenzo Mirone, Andrea Salonia, Alberto Briganti, Francesco Montorsi, and Renzo Colombo Marco MoschiniMarco Moschini More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1691AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of the different types of prostate involvement by urothelial carcinoma (PUC) or prostate adenocarcinoma (PCa) at the time of radical cystoprostatectomy (RCP) has not been fully investigated. METHODS Data from 893 male patients treated with RCP and pelvic lymph node dissection at a tertiary referral center for nonmetastatic bladder cancer between 1992 and 2012 were assessed. Significant PCa was defined as extracapsular disease and/or Gleason Score = 7. Prostatic urothelial carcinoma (PUC) was stratified as stromal versus urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental PCa and PUC on outcomes. RESULTS PCa was present in 319 (35.7%) patients, of which 45 (14.1%) had significant disease. While, the proportion of significant PCa did not change significantly (p=0.8), the rate of indolent PCa increased from 17.1%, to 29.4% to 37.9%, respectively (p<0.001). PUC was identify in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with disease recurrence and cancer-specific mortality. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (Hazard Ratio [HR]:2.01, p=0.03) cancer-specific mortality (HR: 1.65, p=0.01) and overall mortality (HR: 1.45, p=0.03). CONCLUSIONS PCa involvement does not affect outcomes in patients treated with RCP for bladder cancer. Conversely, prostatic stromal invasion with urothelial carcinoma confers a poor survival confirming its aggressiveness. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e729 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marco Moschini More articles by this author Andrea Gallina More articles by this author Giusy Burgio More articles by this author Paolo Dell'Oglio More articles by this author Emanuele Zaffuto More articles by this author Agostino Mattei More articles by this author Rocco Damiano More articles by this author Shahrokh Shariat More articles by this author Vincenzo Mirone More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Prostate Involvement on Outcomes in Patients Treated with Radical Cystoprostatectomy for Bladder Cancer

Objective: The study aimed to evaluate the impact of the different types of prostate involvement at the time of radical cystoprostatectomy (RCP). Methods: Data from 893 male patients treated with RCP at a referral center for bladder cancer (BCa) were assessed. Prostatic urothelial carcinoma (PUC) was stratified as stromal vs. urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental prostate cancer (PCa) and PUC on survival outcomes. Results: PCa was present in 319 (35.7%) RCP patients, of which 45 (14.1%) had significant PCa disease. PUC was identified in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with worse survival outcomes. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (hazards ratio [HR] 2.01, p = 0.03), cancer-specific mortality (HR 1.65, p = 0.01), and overall mortality (HR 1.45, p = 0.03). Conclusion: Prostatic stromal invasion with urothelial carcinoma confers a poor survival expectation to BCa patients after surgical treatment. Conversely, other type of urothelial prostatic invasions or the presence of concomitant PCa does not seem to be associated with differences in survival outcomes.

Clinicopathological Features and Prognostic Value of Incidental Prostatic Adenocarcinoma in Radical Cystoprostatectomy Specimens: A Systematic Review and Meta-Analysis of 13,140 Patients

There is controversy in the literature about the oncologic significance of incidental prostate cancer detected at radical cystoprostatectomy for bladder cancer. An online search was done for studies reporting incidental prostate cancer in cystoprostatectomy specimens. After following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we identified a total of 34 reports containing 13,140 patients who underwent radical cystoprostatectomy for bladder cancer with no previous history of prostate cancer. A cumulative analysis was performed on the available data regarding prevalence, clinicopathological features and oncologic outcomes. RevMan, version 5.3 was used for data meta-analysis. Of the 13,140 patients incidental prostate cancer was detected in 3,335 (24.4%). Incidental prostate cancer was significantly associated with greater age (Z = 3.81, p = 0.0001, d = 0.27, 95% CI -0.14-0.68), lymphovascular invasion of bladder cancer (Z = 2.07, p = 0.04, r = 0.14, 95% CI 0.09-0.18) and lower 5-year overall survival (Z = 2.2, p = 0.03). Among patients with clinically significant and insignificant prostate cancer those with clinically significant prostate cancer significantly more frequently showed a positive finding on digital rectal examination (Z = 3.12, p = 0.002, r = 0.10, 95% CI 0-0.19) and lower 5-year overall survival (Z = 2.49, p = 0.01) whereas no effect of age was observed (p = 0.15). Of1,320 patients monitored for biochemical recurrence prostate specific antigen recurrence, defined as prostate specific antigen greater than 0.02 ng/ml, developed in 25 (1.9%) at between 3 and 102 months. This meta-analysis suggests that incidental prostate cancer detected during histopathological examination of radical cystoprostatectomy specimens might be linked with adverse characteristics and outcomes in patients with invasive bladder cancer.

Incidental prostate cancer diagnosed at radical cystoprostatectomy for bladder cancer: disease-specific outcomes and survival.

BackgroundThe current standard of care for men with muscle-invasive bladder cancer is radical cystoprostatectomy (RCP). One-third of RCP specimens demonstrate incidental prostate cancer, primarily reported in small series with limited follow-up. The aim of this study is to report mature outcomes, including patterns of failure and disease-specific recurrence rates, and survival, for a large cohort of men with incidental prostate cancer at RCP performed at a tertiary referral center.MethodsThis retrospective study describes cancer control and survival rates for men who underwent RCP for bladder cancer and were found incidentally to have prostate cancer. Analysis of patient-, tumor-, and treatment-specific factors were analyzed for association with disease control and survival endpoints.ResultsBetween 2002 and 2010, 94 patients with incidental discovery of prostate cancer postRCP were identified for inclusion in this study. Forty-five patients (45%) underwent RCP for recurrent (rather than initial presentation of) bladder carcinoma. At a median follow-up of 40.3 months (71.2 months for survivors; range, 8.9–155.5 months), 42 patients were alive without recurrence and 52 patients had died (25 associated with disease). The estimated 5-year bladder cancer disease-free, urinary tract malignancy disease-free, and prostate specific antigen (PSA) relapse-free survivals were 76% [95% confidence interval (CI), 65–84%], 64% (52–74%), and 97% (79–100%), respectively. The estimated 5-year urinary tract malignancy-specific and overall survivals were 61% (49–71%) and 52% (41–62%), respectively. Univariate analysis demonstrated associations between pathologic T/N-stage and nodal ratio with bladder cancer disease-free, urinary tract malignancy disease-specific, and overall survivals, with patient age at diagnosis as an additional adverse factor associated with overall survival. Multivariate analysis confirmed pN-stage and age as independently associated with worse survival.ConclusionFor men undergoing RCP for bladder cancer, the present study suggests that incidentally discovered prostate cancers, irrespective of pathologic stage, Gleason score, or clinical significance, do not impact 5-year disease control or survival outcomes.

Prognostic Significance of Incidental Prostate Cancer at Radical Cystoprostatectomy for Bladder Cancer

Objective: The aim of the study was to evaluate the impact of the clinical significance of incidental prostate cancer (PC) on overall survival (OS) after radical cystoprostatectomy (RC) for bladder cancer (BC). Methods: A total of 822 consecutive men underwent RC in 3 academic centers between 1996 and 2011. The clinical significance of incidental PC was determined according to the Epstein criteria. The Kaplan-Meier analysis with log-rank was used to investigate the impact of PC on OS and univariate and multivariate Cox regression analyses for risk factors of OS. The median follow-up was 36 months (interquartile range 10-49). Results: Of the 822 men, 117 (14.2%) had clinically significant, 243 (29.6%) insignificant and 462 (56.2) no PC at RC. Men with PC were at higher risk for lymphovascular invasion (LVI) of BC compared to men without PC (p < 0.001). The 5-year OS for men with clinically significant, insignificant and no PC was 33.3, 51.3 and 51.5%, respectively (p = 0.050). In the subgroup of pN0 patients (n = 601), clinically significant PC was significantly associated with inferior OS (p = 0.044) but not in multivariable analysis (p = 0.46). Conclusions: We did not find the clinical significance of incidental PC to be an independent predictor. However, the positive correlation between incidental PC and LVI of BC deserves further investigation.

648 Incidence and prognosis of clinically significant incidental prostate cancer in radical cystoprostatectomy for bladder cancer

648 Incidence and prognosis of clinically significant incidental prostate cancer in radical cystoprostatectomy for bladder cancer

The Prevalence of Persistent Prostate Cancer after Radiotherapy Detected at Radical Cystoprostatectomy for Bladder Cancer

More than half of the men who receive treatment for prostate cancer elect radiotherapy. After radiotherapy recurrence is determined by an increase in prostate specific antigen and not usually by pathological confirmation. We describe the prevalence of persistent gradable prostate cancer in men treated with radiotherapy for prostate cancer at radical cystoprostatectomy for bladder cancer. A total of 78 patients underwent radiotherapy (brachytherapy and/or external beam radiation) before the development of bladder cancer requiring radical cystectomy at our institution. All tissues were evaluated by a specialized genitourinary pathologist. Median time from radiotherapy to radical cystoprostatectomy was 77 months. Gradable prostate cancer was identified in 45% of patients. Of the tumors 69% were Gleason score 7 or greater, 17% were pT3 or greater and 5% showed positive lymph nodes. Men treated more recently were less likely to have gradable prostate cancer, including 100% before 1980, 49% between 1980 and 2000 and 10% from 2000 to the present (p=0.002) as were those who received external beam radiation alone compared to brachytherapy and combined brachytherapy/external beam radiation (58% vs 27% and 14%, respectively, p=0.005). After radiotherapy 45% of men had persistent prostate cancer (37% of men with no evidence of disease). A decreased prostate cancer rate was associated with later treatment year and combined brachytherapy/external beam radiation regimens. Similar to men treated with radical cystoprostatectomy for muscle invasive bladder cancer, meticulous attention should be paid during prostate removal in men treated with radiotherapy because many may have persistent prostate cancer. In addition, markers other than prostate specific antigen should be studied in men treated with radiotherapy to better identify those with biochemical recurrence.

1265 POSTOPERATIVE ANATOMIC MEASUREMENTS WITH DYNAMIC MAGNETIC RESONANCE IMAGING: ASSOCIATION WITH URINARY CONTINENCE IN ORTHOTOPIC ILEAL NEOBLADDER AFTER RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (I)1 Apr 20131265 POSTOPERATIVE ANATOMIC MEASUREMENTS WITH DYNAMIC MAGNETIC RESONANCE IMAGING: ASSOCIATION WITH URINARY CONTINENCE IN ORTHOTOPIC ILEAL NEOBLADDER AFTER RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER Jonathan Lopater, Antoine Scherrer, Servane Gey, Vincent Delmas, Yann Neuzillet, and Thierry Lebret Jonathan LopaterJonathan Lopater Suresnes, France More articles by this author , Antoine ScherrerAntoine Scherrer Suresnes, France More articles by this author , Servane GeyServane Gey Paris, France More articles by this author , Vincent DelmasVincent Delmas Paris, France More articles by this author , Yann NeuzilletYann Neuzillet Suresnes, France More articles by this author , and Thierry LebretThierry Lebret Suresnes, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2619AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of this study is to use dynamic magnetic resonance (MR) imaging to evaluate the roles of post-operative anatomic measurements in the recovery of urinary continence in orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer. METHODS Five case patients requiring clean intermittent self-catheterization (CISC), and thirty eight control patients who received a dynamic MR imaging with an orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer were evaluated in a prospective study at a single institution. Day-time and noctunal urinary continence was categorized as mode according to CISC requirement, perfect and not perfect continence, as incontinence severity according to pad count and as time to continence. Dynamic MR imaging anatomic measurements of pelvic bone and soft tissue were performed. Multivariate age-adjusted polytomus and ordinal logistic regressions after univariate mean and repartition comparison were performed to assess variables associated with urinary continence mode and incontinence severity. Univariate and multivariate age-adjusted cox regressions were performed to assess variables with time to continence recovery. RESULTS Day-time continence of control patients was perfect in 73.7% and satisfying in 94.7%. Univariate analyses selected 3 variables, but only levator ani thickness at the pouch-urethral anastomosis level predicted day-time urinary continence mode (relative risk ratio [RRR] = 2.14 per mm, perfect against not perfect, 95% CI [1.16, 3.97], p = 0.015), incontinence severity (Ordinal odds ratio = 2.08 per mm, 95% CI [1.27, 3.93], p = 0.007) and time to day-time recovery (Hazard ratio [HR]= 0.82 per mm, 95% CI [0.68, 1.00], p = 0.046). Levator ani muscle at the level of the urethra had a teardrop coronal shape, thicker at the bottom than at the top. Also, levator ani thickness at the pouch-urethral anastomosis level represented postoperative lack of membranous urethral support. CONCLUSIONS Data suggest that lack of membranous urethral support impacts on daytime urinary continence recovery of orthotopic ileoplasty after cystoprostatectomy for bladder cancer. Prognostic value on urinary continence recovery of post-operative peri-sphincteric structures establishes a pathophysiological role to membranous urethral support in men besides innervation. Therefore, preservation of peri-sphincteric structures during surgery is recommended. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e518 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Lopater Suresnes, France More articles by this author Antoine Scherrer Suresnes, France More articles by this author Servane Gey Paris, France More articles by this author Vincent Delmas Paris, France More articles by this author Yann Neuzillet Suresnes, France More articles by this author Thierry Lebret Suresnes, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

930 Magnetic resonance imaging: Postoperative anatomic measurements association with urinary continence in orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer

930 Magnetic resonance imaging: Postoperative anatomic measurements association with urinary continence in orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer

Characterization and risk stratification of prostate cancer in patients undergoing radical cystoprostatectomy

To describe the prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy for bladder malignancy; to quantify the association between incidental prostate cancer and mortality in these patients; and to quantify the association between incidental prostate cancer and age in radical cystoprostatectomy specimens. Consecutive patients undergoing radical cystoprostatectomy for bladder malignancy at six academic institutions were assessed. End-points were the histological diagnosis of prostate cancer in the radical cystoprostatectomy specimens and mortality. The association between incidental prostate cancer and mortality was calculated by multivariable Cox regression, and the association between age and the occurrence of prostate cancer was calculated by logistic regression. A total of 1122 patients (aged 65.6 ± 10 years) were included in this analysis. Prostate cancer was detected in 17.8% (n = 200) of the cystoprostatectomy specimens. After multivariable adjustment, prostate cancer was significantly associated with mortality (hazard ratio 1.27, 95% confidence interval 1.03-1.56). There was a significant association between age and the presence of prostate cancer in the cystoprostatectomy specimen. The odds ratio for the presence of prostate cancer was 1.028 (95% confidence interval 1.011-1.045; P < 0.001) per each year after the age of 40 years. Concomitant prostate cancer is an independent prognostic factor for mortality after radical cystoprostatectomy for bladder cancer. When considering a prostate-sparing technique, urologists should consider that every fifth to sixth patient will present with a concomitant prostate cancer, and that after the age of 40 years, the odds of a concomitant prostate cancer increases by 2.8% per year, thus warranting a careful balance between the oncological risks and quality of life issues.