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Prostatic capsule and seminal vesicle-sparing cystectomy: improved functional results, inferior oncologic outcome.
Urology 2008 July
OBJECTIVES: To retrospectively evaluate the functional and oncologic results of 20 prostatic capsule and seminal vesicle-sparing cystectomies.
METHODS: From June 2002 to January 2006, we performed 360 radical cystectomies, for 20 of which we used a prostatic capsule and seminal vesicle-sparing technique. Patients with Stage T1G3 bladder cancer resistant to intravesical immunotherapy or monofocal T2G3 tumors at transurethral resection of the bladder (TURB) and with preoperative normal sexual function met our inclusion criteria and underwent this procedure. Patients with involvement of the prostatic urethra or multiple tumors were excluded. Prostate-specific antigen measurement, digital rectal examination, and transrectal ultrasonography were performed preoperatively in order to avoid incidental prostate cancer findings. No patient had a preoperative prostate-specific antigen level greater than 4 ng/mL; therefore, no patient underwent preoperative prostate biopsy. The mean patient age was 57.1 years (range 39 to 66).
RESULTS: Sexual function recovery and daytime and nighttime continence were reached for all patients. The local recurrence rate in our series was 20% at 2 years of follow-up. Moreover, the distant failure rate was 30%. The 1-year cancer-specific mortality rate was 10% and the 2-year rate was 20%. All disease progressions occurred in patients with Stage T2G3 tumor at TURB.
CONCLUSIONS: At last follow-up, patients with Stage T1G3 tumor at TURB had not experienced disease progression. Longer follow-up and a larger cohort of patients are necessary to confirm the safety of this procedure in these patients. In our series, the local recurrence and distant metastasis rates were too high compared with those of the patients who underwent radical cystectomy without the sparing technique. Eight of ten patients with muscle invasive bladder cancer at TURB, 8 had disease progression after seminal vesicle-sparing cystectomy.
METHODS: From June 2002 to January 2006, we performed 360 radical cystectomies, for 20 of which we used a prostatic capsule and seminal vesicle-sparing technique. Patients with Stage T1G3 bladder cancer resistant to intravesical immunotherapy or monofocal T2G3 tumors at transurethral resection of the bladder (TURB) and with preoperative normal sexual function met our inclusion criteria and underwent this procedure. Patients with involvement of the prostatic urethra or multiple tumors were excluded. Prostate-specific antigen measurement, digital rectal examination, and transrectal ultrasonography were performed preoperatively in order to avoid incidental prostate cancer findings. No patient had a preoperative prostate-specific antigen level greater than 4 ng/mL; therefore, no patient underwent preoperative prostate biopsy. The mean patient age was 57.1 years (range 39 to 66).
RESULTS: Sexual function recovery and daytime and nighttime continence were reached for all patients. The local recurrence rate in our series was 20% at 2 years of follow-up. Moreover, the distant failure rate was 30%. The 1-year cancer-specific mortality rate was 10% and the 2-year rate was 20%. All disease progressions occurred in patients with Stage T2G3 tumor at TURB.
CONCLUSIONS: At last follow-up, patients with Stage T1G3 tumor at TURB had not experienced disease progression. Longer follow-up and a larger cohort of patients are necessary to confirm the safety of this procedure in these patients. In our series, the local recurrence and distant metastasis rates were too high compared with those of the patients who underwent radical cystectomy without the sparing technique. Eight of ten patients with muscle invasive bladder cancer at TURB, 8 had disease progression after seminal vesicle-sparing cystectomy.
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