Concomitant pathology in the prostate in cystoprostatectomy specimens: a prospective study and review.
OBJECTIVE
To investigate possible associated pathology in the prostate removed from patients with invasive bladder cancer and determine if there is a justification for prostate-sparing cystectomy.


METHODS
Between March 2005 and July 2007, 425 men (mean age 59 years, sd 8.23) had a cystoprostatectomy at our institute. The prostate was step sectioned at 2-3 mm intervals and any associated pathology determined; patient and tumour characteristics were correlated with prostatic pathology. The results were compared with those published previously, and the potential functional advantages of prostate sparing are reviewed and discussed.


RESULTS
Prostatic adenocarcinoma was detected in 90 of the 425 (21.2%) patients. There was no significant correlation between preoperative prostate-specific antigen level and the presence of adenocarcinoma, Gleason score or prostatic tumour stage. There was prostatic involvement as a result of direct invasion by the primary bladder tumour (contiguous) in 39 cases (9.2%). Concomitant (non-contiguous) transitional cell carcinoma of the prostatic urethra and/or ducts was detected in 27 specimens (6.4%). Additional findings were high-grade prostatic intraepithelial neoplasia in 43 patients (10.1%) and benign prostatic hyperplasia in 175 (41.2%).


CONCLUSIONS
We think that the potential oncological risks of prostate-sparing cystectomy outweigh any small and possible functional benefits; accordingly, the prostate should not be retained.
Department of Urology, Urology and Nephrology Centre, Mansoura, Egypt.
Mohamed
M
Saad
Mona
M
Abdel-Rahim
Hassan
H
Abol-Enein
Mohammed A
MA
Ghoneim
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology / Q000601:surgery; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery