Developing Selection Criteria for Prostate-sparing Cystectomy: A Review of Cystoprostatectomy Specimens

Objectives To determine risk factors for prostate pathology, which may serve as guidelines for identifying patients who may be inappropriate for prostate-sparing cystectomy for treatment of transitional cell cancer of the bladder. Methods After obtaining Institutional Review Board approval, we reviewed the clinical and pathologic data from consecutive men treated with radical cystoprostatectomy (RCP) between January 2003 and September 2008. We reviewed the RCP pathology for prostatic involvement by transitional cell carcinoma (PI-TCC) as well as presence of prostate cancer (PCa). Univariate analysis was used to test for association of clinical parameters with prostatic involvement in RCP specimens. Results A total of 96 patients with a median age of 67 (interquartile range: 47, 79) underwent RCP between January 2003 and September 2008. PI-TCC was present in 24 patients (25%) of which 6 (25%) had carcinoma in situ (CIS) only and 18 (75%) had stromal invasion. We identified PCa in 40 patients (42%). CIS (odds ratio, 3.2, P = .018) and tumor situated at or below the trigone (odds ratio, 3.3, P = .046) at the pre-RCP transurethral bladder tumor resection were associated with PI-TCC. Conclusions PI-TCC and PCa are common findings at RCP. The location of the bladder tumor situated at or below the trigone and the presence of CIS at transurethral bladder tumor resection is associated with increased risk for PI-TCC and should be considered at least relative contraindications for prostate-sparing cystectomy. A thorough investigation for PCa should be conducted for all possible candidates.