title: Indications for preoperative prostate biopsy in patients undergoing radical cystoprostatectomy for bladder cancer.
abstract: OBJECTIVE
  We determined indications for preoperative prostate biopsy in patients undergoing radical cystoprostatectomy for bladder cancer.
  
  
  METHODS
  Of 316 cystoprostatectomy specimens concomitant prostate cancer was diagnosed in 21.5%. Prostate cancer was diagnosed preoperatively in 24% of cases (evident prostate cancer), 32% were suspicious for prostate cancer but no biopsy was done (suspected prostate cancer) and in 44% prostate cancer was incidental. Patients were stratified into probability groups of intermediate/high risk prostate cancer by digital rectal examination and prostate specific antigen. The incidence of unfavorable histopathology was determined in each group.
  
  
  RESULTS
  Of prostate cancers 85% were organ confined and the Gleason score was favorable (2-6) in 74%. Of cases of incidental prostate cancer tumors were organ confined in 97%. There were no unfavorable Gleason scores (8-10). In the low probability group 83% of patients had organ confined prostate cancer and only 17% had an unfavorable Gleason score. In the intermediate probability group prostate cancer was organ confined in 73% of patients, 45% had a favorable Gleason score (2-6) and 55% had an intermediate Gleason score (7). In the high probability group 29% of patients had high risk prostate cancer.
  
  
  CONCLUSIONS
  Most concomitant prostate cancers were organ confined and had a favorable or intermediate Gleason score when digital rectal examination was not suspicious and prostate specific antigen was less than 10 ng/ml. As a consequence, patients with a low/intermediate probability of detecting intermediate/high risk prostate cancer do not require preoperative prostate biopsy unless nerve sparing surgery is planned. In contrast, all patients should undergo preoperative biopsy for prostate cancer when digital rectal examination is suspicious or prostate specific antigen is more than 10 ng/ml because the rate of high risk prostate cancer was 29% in this group.
authors.affiliation: Department of Urology, Johannes Gutenberg University, Mainz, Germany. thomas@urologie.klinik.uni-mainz.de
authors.forename: Christian
authors.initials: C
authors.lastname: Thomas
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesner
authors.forename: Sebastian
authors.initials: S
authors.lastname: Melchior
authors.forename: Rolf
authors.initials: R
authors.lastname: Gillitzer
authors.forename: Folke
authors.initials: F
authors.lastname: Schmidt
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen