title: Oncological evaluation of prostate sparing cystectomy: the Montsouris long-term results.
abstract: OBJECTIVE
  Prostate sparing cystectomy provides an alternative therapeutic option in highly selected patients with invasive bladder cancer who wish to avoid the significant functional side effects of traditional surgery. Concern exists regarding the oncological safety of this technique especially with regard to the presence of prostatic urothelial cancer and incidental prostate adenocarcinoma. We present the long-term oncological outcomes of a large series of patients treated at a single institution.
  
  
  METHODS
  Between October 1992 and June 2004 a total of 117 patients were selected for prostate sparing cystectomy after meeting the inclusion criteria.
  
  
  RESULTS
  Nine patients underwent radical cystoprostatectomy after prostate urothelial carcinoma was diagnosed intraoperatively. Long-term oncological results (2 years minimum followup [mean 55 months]) are presented here for the remaining patients. The rate of local and distant recurrence was 4.7% and 34%, respectively, at 20 months. Overall survival at 5 years in our study was 67%, and 5-year disease-free survival rates were 77% for pT2 N0 or less, 44% for pT3 N0 or greater and 22% for pN+ disease. Of 6 patients found to have prostate adenocarcinoma in transurethral prostate resection specimens 1 was treated with high intensity focused ultrasound and 5 were followed with active surveillance, 2 of whom later died of bladder cancer.
  
  
  CONCLUSIONS
  We report oncological data on the largest prospective cohort of patients, with the longest followup, treated by prostate sparing cystectomy to date. Outcomes are comparable with the largest published series of cystoprosatectomies. With appropriate screening the risk of a clinically significant prostate cancer appears to be low. For certain selected patients this technique represents a valuable additional option for treatment.
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. francois.rozet@imm.fr
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lesur
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Gordon
authors.initials: G
authors.lastname: Smyth
authors.forename: Shawn
authors.initials: S
authors.lastname: Soon
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods