Incidental prostate cancer in patients with radical cystectomy for bladder cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 225-225
Author(s):  
Hooman Djaladat ◽  
Max H. Bruins ◽  
Eila C. Skinner ◽  
Gus Miranda ◽  
Jie Cai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Transitional Cell ◽  
Prostate Adenocarcinoma ◽  
Adjuvant Radiation ◽  
Incidental Prostate Cancer ◽  
Hormone Ablation ◽  
Multifocal Disease

225 Background: Radical cystectomy is the gold standard surgical treatment for invasive bladder cancer. Prostate adenocarcinoma is often found incidentally in the cystoprostatectomy specimen. The clinical significance of this type of cancer has not been well characterized. We reviewed the cohort of male patients with bladder cancer who underwent radical cystectomy and found to have incidental prostate adenocarcinoma. Methods: 1,964 patients with primary transitional cell carcinoma of bladder underwent radical cystectomy between 1971 and 2008 with a median follow-up of 12.1 yrs (0.1-36) at USC. 1553 of them were male (79%) and 559 (36%) had incidental pathologic prostate adenocarcinoma (PC-group). Prostate and bladder cancer characteristics, recurrence and overall survival (OS) in the cohort of PC-group are reviewed. Results: Median age in the PC-group was 69 yo (35-92). The incidental PC was organ confined (OC) in 527 patients (94%). 32 (6%) had non-OC prostate cancer, treated by adjuvant radiation (5), hormone ablation (3) with a median follow-up of 3.9 yrs (0.1-16). Median pre-op PSA was 1.66 (0.01-83) in PC-group and 1.31 (0.01-33.2) in non-PC group. Gleason score was ≤ 6 in 458 (82%), 7 in 78 (14%) and ≥ 8 in 12 (2%) cases. Reviewing bladder cancer in the PC vs. non-PC group, 84 and 83% had high-grade cancer, 63 and 58% had associated CIS, 41 and 36% had multifocal disease and 29 and 27% had LVI respectively (P > 0.05). Incidental PC did not have significant effect on recurrence (P=0.3) and OS (P=0.4) after cystectomy for bladder urothelial cancer. No patient died of PC. 5-year OS rate was 60 ± 2% in both PC and non-PC groups. 10-year OS rate was also comparable at 42 ± 2% in PC and 44 ± 2% in non-PC-group. Conclusions: Incidental prostate adenocarcinoma is reported in more than one third of patients who undergo radical cystectomy for bladder cancer. It is organ confined in most of the cases and has no correlation with bladder cancer stage. Outcome of patients with incidental prostate adenocarcinoma at the time of radical cystectomy relies exclusively on the bladder cancer.

Patterns of failure after radical cystectomy for pT3-4 bladder cancer: Implications for adjuvant radiation therapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 370-370
Author(s):  
Abhinav V. Reddy ◽  
Joseph J. Pariser ◽  
Shane M. Pearce ◽  
Ralph R. Weichselbaum ◽  
Norm D. Smith ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radiation Therapy ◽  
Radical Cystectomy ◽  
Multivariable Analysis ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Risk Patients ◽  
Pn Stage

370 Background: In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods: Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariable analysis for association with LF and overall survival. Results: 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 and median follow up was 11 months. On univariate analysis, margin status, pT stage, pN stage, and gender were all associated with LF (p < 0.05), however, on multivariable analysis, only pT and pN stage were significantly associated with LF (p < 0.01). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external/internal iliac LNs and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions: Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

Oncological outcomes of radical cystectomy for bladder cancer: Laparoscopy versus open surgery

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16059-e16059
Author(s):  
J. Guillotreau ◽  
X. Gamé ◽  
M. Mouzin ◽  
N. Doumerc ◽  
B. Malavaud ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Open Surgery ◽  
Randomized Study ◽  
Transitional Cell ◽  
Surgical Margin ◽  
Rank Test ◽  
Positive Surgical Margin ◽  
Oncological Outcomes

e16059 Background: To compare the oncological outcomes of laparoscopic versus open surgery in radical cystectomy for bladder cancer. Methods: A prospective non-randomized study was conducted between January 2003 and November 2008 in 52 patients, 2 women and 50 men, who underwent radical cystectomy for bladder cancer. Thirty seven cystectomies were carried out by laparoscopic surgery (LS) and 15 by open surgery (OS). Mean patient age was 67.3 ± 9.7 years. The median preoperative ASA score was 2 (1–3) in both groups. Kaplan-Meier curves were constructed to estimate the survival rate for the whole sample. Datas were compared by Log-rank test. Current followup, overall and specific deaths were used as endpoints. The survival time was defined as the time elapsed from the date of radical cystectomy to the endpoint. Results: All tumours were transitional cell carcinoma, high-grade and stage < pT3b pN0. One patient of OS group had a positive surgical margin. Eight patients (15.4%), 7 of LS group and 1 of OS group, completed 5 years of follow-up. At the last follow-up 40 patients (76.9%) were alive with no evidence of disease and 5 (9.6%) died, two patients (3.8%) from metastasis and 3 (5.7%) from different causes. No patient developed port- site metastasis. Overall survival was significantly better in LS group than in the OS group (p=0.039). No statistical difference was noted for Specific survival. Mean patient follow-up was 30.9 ± 20.3 months. Conclusions: The data suggest that LRC provides oncological outcomes comparable to contemporary series of open RC. No significant financial relationships to disclose.

scholarly journals Relevance of prostate cancer in patients with synchronous invasive bladder urothelial carcinoma: a monocentric retrospective analysis

2015 ◽  
Vol 87 (1) ◽  
pp. 76 ◽  
Author(s):  
Lucio Dell’Atti
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Statistical Significance ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Cancer Specific Survival ◽  
Incidental Prostate Cancer ◽  
Clinically Significant

Objectives: We retrospectively reviewed data of patients with incidental prostate cancer (PCa) who underwent radical cystoprostatectomy (RCP) for invasive bladder cancer and we analyzed their features with regard to incidence, pathologic characteristics, clinical significance, and implications for management. Material and Methods: Clinical data and pathological features of 64 patients who underwent standard RCP for bladder cancer were included in this study. Besides the urothelial carcinoma of the urinary bladder, the location and tumor volume of the PCa, prostate apex involvement, Gleason score, pathological staging and surgical margins were evaluated. Clinically significant PCa was defined as a tumor with a Gleason 4 or 5 pattern, stage ≥ pT3, lymph node involvement, positive surgical margin or multifocality of three or more lesions. Postoperative follow-up was scheduled every 3 months in the first year, every 6 months in the second and third year, annually thereafter. Results: 11 out of 64 patients (17.2%) who underwent RCP had incidentally diagnosed PCa. 3 cases (27.3%) were diagnosed as significant PCa, while 8 cases (72.7%) were clinically insignificant. The positive surgical margin of PCa was detected in 1 patient with significant disease. The prostate apex involvement was present in 1 patient of the significant PCa group. Median follow-up period was 47.8 ± 29.2 (range 4-79). During the follow-up, biochemical recurrence occurred in 1 patient (9%). Concernig the cancer specific survival there was no statistical significance (P = 0.326) between the clinically significant and clinical insignificant cancer group. Conclusions: In line with published studies, incidental PCa does not impact on the prognosis of bladder cancer of patients undergoing RCP.

Incidental prostate cancer detected in cystoprostatectomy specimens in patients treated with radical cystectomy for bladder cancer

2016 ◽  
Vol 15 (10) ◽  
pp. e1296
Author(s):  
C. Fragkoulis ◽  
G. Katsagounos ◽  
K. Stasinopoulos ◽  
G. Stathouros ◽  
G. Papadopoulos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Incidental Prostate Cancer

scholarly journals Incidentally Found Prostate Cancer and Influence on Overall Survival after Radical Cystoprostatectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Algimantas Sruogis ◽  
Albertas Ulys ◽  
Giedre Smailyte ◽  
Zygimantas Kardelis ◽  
Arunas Kulboka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Bladder Cancer ◽  
Incidental Prostate Cancer ◽  
Vital Status ◽  
Radical Cystoprostatectomy ◽  
Clinically Significant ◽  
Using Data ◽  
Extraprostatic Extension

Objectives. To determine incidentally found prostate cancer frequency and impact on overall survival after RCP.Patients and Methods. The records of 81 men who underwent cystoprostatectomy from January 2000 to December 2009 were reviewed. The vital status of the study group was assessed as on September 1, 2009, by passive followup, using data from the population registry.Results. The 81 men underwent RCP. The incidental prostate cancer was found in the specimens of 27 (33.3%) patients. 13 (48.1%) of 27 prostate cancer cases were clinically significant. For 3 patients (11.1%) an extraprostatic extension was found. For 2 patients (7.4%)—positive margins, for 1 patient (3.7%)—Gleason sum 8, and for the rest 7 patients bigger than 0.5 cm3volume tumor, and Gleason sum 7 was found. The mean follow-up time was months (varies from 0.8 to 131.2 months). The patients with bladder cancer and incidentally found prostate cancer lived shorter ( and months). Higher overall survival () was found in the patient group with bladder cancer without incidentally diagnosed prostate cancer.Conclusion. There are indications that in this small study prostate cancer has influenced on patients' survival with bladder cancer after radical cystoprostatectomy.

Incidental prostate cancer in patients who underwent radical cystectomy for high risk non muscle invasive bladder cancer: Is it clinically significant?

2021 ◽  
pp. 039156032110199
Author(s):  
Charalampos Fragkoulis ◽  
Ioannis Glykas ◽  
Victoria Mari ◽  
Stavros Lamprou ◽  
Lazaros Tzelves ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Tumor Volume ◽  
Muscle Invasive Bladder Cancer ◽  
Incidental Prostate Cancer ◽  
Clinically Significant ◽  
Muscle Invasive ◽  
Extraprostatic Extension

Introduction and objective: Non muscle invasive, high-risk, bladder cancer is an entity which is usually treated with radical cystectomy. Incidental prostate cancer refers to prostate cancer detected in radical cystectomy specimens in patients with no signs of the disease. Objective of this study is to report the prevalence, characteristics, and clinical significance of incidental prostate cancer in non-muscle invasive bladder cancer patients treated with radical cystectomy in our department. Material and methods: We retrospectively reviewed data from 41 patients who underwent radical cystectomy for non-muscle invasive, high risk, bladder cancer during the years 2016–2020 in our department. Prostate cancer was described as clinically significant when there were positive surgical margins, extraprostatic extension, Gleason score >6, or tumor volume ⩾0.5 cm3. Two groups of patients were formed according to the presence or absence of clinically significant prostate cancer. Results: Incidental prostate cancer in the cystectomy specimens was detected in 21 of the 35 patients investigated. Clinically significant prostate cancer was detected in five patients. Positive surgical margins and extraprostatic extension were present in one patient, respectively. Gleason score was more than six in four of the five patients and PCa tumor volume was above 0.5 cm3 in three patients. Two patients with clinically significant prostate cancer were diagnosed with biochemical recurrence during their follow up. Conclusions: In non-muscle invasive, high-risk patients undergoing radical cystectomy, clinically significant incidental PCa is an important issue as it may affect prognosis, quality of life, metastasis free survival, and overall survival.

scholarly journals Preoperative Serum Gamma-Glutamyltransferase as a Prognostic Biomarker in Patients Undergoing Radical Cystectomy for Bladder Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Shiqiang Su ◽  
Lizhe Liu ◽  
Chao Sun ◽  
Yanhua Nie ◽  
Hong Guo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Elevated Serum ◽  
Disease Free Survival ◽  
Prognostic Models ◽  
Lymph Node Status ◽  
Cancer Specific Survival ◽  
Gamma Glutamyltransferase ◽  
Preoperative Serum

BackgroundSerum gamma-glutamyltransferase (GGT) has been reported to be correlated with survival in a variety of malignancies. However, its effect on patients with bladder cancer (BC) treated by radical cystectomy has never been evaluated.Patients and MethodsWe retrospectively evaluated 263 patients who underwent radical surgery in our center. Baseline features, hematologic variables, and follow-up data were obtained. The endpoints included overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). The relationship between GGT and survival were evaluated.ResultsThe median follow-up period for all patients was 34.7 (22.9-45.9) months. At the last follow-up, 67 patients died, 51 patients died of cancer, 92 patients experienced disease recurrence. Patients with an elevated serum GGT had a higher rate of pT3-T4 tumors. Patients with a higher preoperative serum GGT had a lower rate of OS, CSS and DFS (P &lt; 0.001 for all). Multivariate analysis identified that preoperative serum GGT was independent predictor of OS (HR: 3.027, 95% CI: 1.716-5.338; P &lt; 0.001), CSS (HR: 2.115, 95% CI: 1.093-4.090; P = 0.026), DFS (HR: 2.584, 95% CI: 1.569-4.255; P &lt; 0.001). Age, diabetes history, pathologic T stage, and lymph node status also were independent predictors of prognosis for BC patients.ConclusionsOur results indicated that preoperative serum GGT was an independent prognosis predictor for survival of BC patients after radical cystectomy, and can be included in the prognostic models.

A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

2021 ◽  
pp. 205141582110414
Author(s):  
Francesco Chiancone ◽  
Francesco Persico ◽  
Marco Fabiano ◽  
Maurizio Fedelini ◽  
Clemente Meccariello ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Multivariate Logistic Regression Model ◽  
Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

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