Laura S Mertens1, Richard P Meijer2, Remco R de Vries3, Jakko A Nieuwenhuijzen4, Henk G van der Poel1, Axel Bex1, Bas W G van Rhijn1, Wim Meinhardt1, Simon Horenblas5. 1. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 2. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Urology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands. 4. Department of Urology, VU University Medical Center, Amsterdam, The Netherlands. 5. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: s.horenblas@nki.nl.
Abstract
PURPOSE: We evaluated long-term oncologic and functional results after prostate sparing cystectomy for bladder cancer. MATERIALS AND 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.
PURPOSE: We evaluated long-term oncologic and functional results after prostate sparing cystectomy for bladder cancer. MATERIALS AND 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: R Colombo; F Pellucchi; M Moschini; A Gallina; R Bertini; A Salonia; P Rigatti; F Montorsi Journal: World J Urol Date: 2015-01-11 Impact factor: 4.226
Authors: Friedrich Carl von Rundstedt; Seth P Lerner; Guilherme Godoy; Gilad Amiel; Thomas M Wheeler; Luan D Truong; Steven S Shen Journal: J Urol Date: 2014-08-12 Impact factor: 7.450
Authors: Juan Gómez Rivas; Sergio Alonso Y Gregorio; Ángel Tabernero Gómez; Mario Alvarez-Maestro; Jesús Díez Sebastián; Jesús Cisneros Ledo Journal: Cent European J Urol Date: 2016-01-18