title: Usefulness of transurethral biopsy for staging the prostatic urethra before radical cystectomy.
abstract: OBJECTIVE
  We determined the likelihood that transurethral resection biopsy of the prostatic urethra adjacent to the verumontanum would detect prostatic involvement of urothelial carcinoma in patients with bladder carcinoma.
  
  
  METHODS
  We compared precystectomy transurethral resection biopsy specimens of the prostatic urethra with those of the matched radical cystoprostatectomy in 272 patients with urothelial carcinoma of the bladder. All prostates were evaluated by whole mount step sections.
  
  
  RESULTS
  Prostatic involvement by urothelial carcinoma was detected by transurethral resection biopsy or radical cystoprostatectomy in 101 patients (37.1%). Transurethral resection biopsy detected urothelial carcinoma in 72 cases with 71.3% sensitivity and 100% specificity. The overall accuracy of transurethral resection biopsy to detect urothelial carcinoma of the prostate was 89% (positive and negative predictive values 100% and 86%, respectively). Invasive prostatic urothelial carcinoma arising from the prostatic urethra was detected by transurethral resection biopsy in 21 of 26 patients (81%) while prostatic carcinoma in situ was detected in 39 of 52 (75%). Transurethral resection biopsy detected prostatic invasive urothelial carcinoma resulting from transmural invasion of a bladder tumor in 4 of 15 patients.
  
  
  CONCLUSIONS
  Prostatic involvement by urothelial carcinoma of the bladder was found in 37.1% of patients. Transurethral resection biopsy missed most tumors resulting from transmural invasion of the bladder primary lesion. Carcinoma in situ and invasive urothelial carcinoma arising from the prostatic urethra were detected in most cases. Transurethral resection biopsy of the prostatic urethra can complement staging and support clinical decision making with respect to neoadjuvant chemotherapy and planning for an orthotopic neobladder.
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Friedrich Carl
authors.initials: FC
authors.lastname: von Rundstedt
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Gilad
authors.initials: G
authors.lastname: Amiel
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wheeler
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
authors.forename: Luan D
authors.initials: LD
authors.lastname: Truong
authors.affiliation: Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas. Electronic address: stevenshen@houstonmethodist.org.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Shen
mesh_terms: D001706:Biopsy / Q000379:methods; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology*; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: biopsy; carcinoma; prostate; urinary bladder; urothelium
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