Radical cystectomy in patients previously treated for localized prostate cancer.
OBJECTIVE
To present outcomes of a contemporary series of patients undergoing radical cystectomy (RC) for bladder cancer after previous treatment for localized cancer of the prostate (CaP).


METHODS
A retrospective review of more than 1000 RCs performed for bladder cancer between 1995 and 2008 identified 49 patients previously treated for localized CaP. Patients were stratified according to the type of primary therapy received for CaP: any form of primary or adjuvant radiotherapy (brachytherapy or external beam radiotherapy) versus radical prostatectomy (RP) monotherapy. Perioperative data were analyzed and compared between the 2 groups.


RESULTS
Of 49 patients, 40 (82%) underwent primary or adjuvant radiotherapy and 9 (18%) RP alone. Eleven (22%) patients received a continent diversion. Mean estimated blood loss (EBL) and hospital stay were 979 mL and 12 days, respectively. Extravesical disease (≥pT3a) was present in 23 patients (57.5%) in the radiotherapy group and in 2 patients (22%) in the RP group. Ten patients (all in the radiotherapy group) had a positive margin, 9 (90%) of whom had pathologic T4 disease. The overall major perioperative complication rate was 41%. Of the 6 patients with an ONB (all after RP), 4 had severe incontinence.


CONCLUSIONS
Patients undergoing RC after previous treatment for localized CaP are at increased risk for perioperative morbidity. Patients should be counseled that orthotopic diversion after RP may be associated with significant incontinence. Extravesical disease is more prevalent in patients treated with previous radiation. We observed a high rate of positive margins associated with pathologic T4 disease in this cohort.
Jayram
Gautam
G
Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois 60637, USA. gautam.jayram@uchospitals.edu
Katz
Mark H
MH
Steinberg
Gary D
GD
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D018288:Carcinoma, Small Cell / Q000209:etiology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000209:etiology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000150:complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012306:Risk; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology; D001743:Urinary Bladder / Q000528:radiation effects; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000209:etiology; D001749:Urinary Bladder Neoplasms / Q000209:etiology / Q000601:surgery*; D014547:Urinary Diversion