title: Prostate sparing cystectomy for bladder cancer: 20-year single center experience.
abstract: OBJECTIVE
  We evaluated long-term oncologic and functional results after prostate sparing cystectomy for bladder cancer.
  
  
  METHODS
  A total of 120 patients with cT1-4N0-3 bladder cancer were treated with prostate sparing cystectomy between 1994 and 2013, of whom 110 had a followup of 2 years or greater and were eligible for analysis. To rule out tumor in the bladder neck, prostatic urethra or prostate cancer all patients underwent preoperative transurethral biopsy of the bladder neck and prostatic urethra, prostate specific antigen measurement and transrectal ultrasound with biopsies. We assessed oncologic outcomes (disease specific and recurrence-free survival), recurrence rates, prostate cancer and functional results (continence, voiding, and erectile and ejaculatory function).
  
  
  RESULTS
  Mean patient ± SD age was 56.2 ± 8.3 years and median followup was 77.0 months (IQR 57-116). Two and 5-year disease specific survival rates were 76.2% and 66.5%, 2 and 5-year recurrence-free survival rates were 71.2% and 66.6%, and distant and local recurrence rates were 34.2% and 10.0%, respectively. One local recurrence was in the remnant prostatic urothelium. Prostate cancer was diagnosed in 2.7% of cases. Complete daytime and nighttime continence was achieved in 96.2% and 81.9% of patients, and erectile function and antegrade ejaculation were intact in 89.7% and 35.5%, respectively.
  
  
  CONCLUSIONS
  Our long-term data show that prostate sparing cystectomy is an oncologically safe procedure with excellent functional results in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the prostatic urethra/bladder neck and no prostate cancer.
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Mertens
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Meijer
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Urology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
authors.forename: Remco R
authors.initials: RR
authors.lastname: de Vries
authors.affiliation: Department of Urology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jakko A
authors.initials: JA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Bas W G
authors.initials: BW
authors.lastname: van Rhijn
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Meinhardt
authors.affiliation: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: s.horenblas@nki.nl.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
mesh_terms: D015653:Cystectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D059351:Organ Sparing Treatments; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: carcinoma; cystectomy; disease-free survival; prostate; transitional cell; urinary bladder neoplasms