title: Risk assessment of prostatic pathology in patients undergoing radical cystoprostatectomy.
abstract: OBJECTIVE
  To determine the incidence and location of prostate adenocarcinoma (PCa) and prostatic urothelial carcinoma (PUC) for patients undergoing radical cystoprostatectomy (RCP) for bladder cancer and to ascertain what preoperative information may be useful in predicting PUC or PCa in patients who may be candidates for prostate-sparing cystectomy.
  
  
  METHODS
  Between 2001 and 2004, 235 consecutive patients underwent RCP and had whole-mount sections of the prostate. We reviewed our prospective radical cystectomy database for preoperative clinicopathological information associated with each patient. The bladder and whole-mount prostate sections were re-reviewed to determine the location and depth of the bladder tumor as well as the presence of any associated PCa and PUC.
  
  
  RESULTS
  We identified 113 of 235 (48%) and 77 of 235 (33%) men with PCa and PUC, respectively. Among patients with PCa, 33 (29%) had Gleason score of > or = 7, 25 (22%) had PCa tumor volume > 0.5 cc, and 15 (13%) had extracapsular extension. On multivariable analysis, only increasing age was significantly associated with PCa (odds ratio=1.3, p=0.046). Of the 77 with PUC, 28 (36%) had in situ disease only, while 49 (64%) had prostatic stromal invasion. Bladder tumor location in the trigone/bladder neck (p<0.001) and bladder carcinoma in situ (p<0.001) was strongly associated with PUC in the final specimen. Overall, 158 (67%) had either PCa or PUC in the prostate.
  
  
  CONCLUSIONS
  PCa and/or PUC is present in a majority of RCP specimens. Current preoperative staging and tumor characteristics are not adequate for determining who can safely be selected for prostate-sparing cystectomy.
authors: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Joseph A
authors: JA
authors: Pettus
authors: Hikmat
authors: H
authors: Al-Ahmadie
authors: Daniel A
authors: DA
authors: Barocas
authors: Theresa M
authors: TM
authors: Koppie
authors: Harry
authors: H
authors: Herr
authors: S Machele
authors: SM
authors: Donat
authors: Guido
authors: G
authors: Dalbagni
authors: Victor E
authors: VE
authors: Reuter
authors: Semra
authors: S
authors: Olgac
authors: Bernard H
authors: BH
authors: Bochner
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D015653:Cystectomy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000601:surgery*