Turk Uroloji Dergisi, vol.32, no.4, pp.467-471, 2006 (SCI-Expanded)
Introduction: Standard radical cystectomy in males for the bladder cancer consists of removal of bladder, prostate, seminal vesicles and vasa deferentia. On the other hand prostate sparing radical cystectomy is a new surgical approach for the treatment of male bladder cancer. We assessed the characteristics, of the patients with bladder cancer who underwent prostate sparing radical cystectomy. Materials and Methods: We reviewed retrospectively 131 male patients with invasive bladder cancer who underwent radical cystoprostatectomy at our department from January 1994 to March 2006. All patients were evaluated with biochemical and hemathological tests, serum prostate specific antigen levels, digital rectal examination, abdomino-pelvic computerized tomography and transrectal ultrasonogphy when necessary. 10 patients with occult prostate adenocancer were excluded. Preoperative cystouretroscopy and computerized tomographies (CT) of all patients were reviewed. The criteria of prostatic involvement was detection of tumor in bladder neck and prostatic urethra. The pathological specimens of patients, those were evaluated in our hospital's pathology department were compared with preoperative tests. Students' t-test and chi-square tests were used for statistical analyses and p<0,05 value was accepted statistically significant. Results: 10 patients were excluded due to coincidental prostate cancer. The mean age of our patients was 57.9±11.17 years. Postoperative pathological stage was pT1 in 11 (9.1%) patients, pT2 in 42 (34.7%) patients, pT3 in 51 (%42.1) patients and pT4 in 17 (14.1%) patients. According to postoperative pathological results, the sensitivity and specificity of cystouretroscopy alone were 66% and 80%, the sensitivity and specificity of CT alone were 46% and 75%, the sensitivity and specificity of cystouretroscopy+CT were 42% and 95%. Positive predictive value of cystouretroscopy, CT and cystouretroscopy+CT was 76%, 65% and 90% respectively. A statistically significant difference was found between CT and cystouretroscopy+CT according to the positivity of tests (p<0.05). Conclusion: Radical cystectomy is highly morbid, as it results in many changes in quality of life including sexual and social function. Prostate sparing radical cystectomy has been tried at many centers to improve quality of life. Preoperative evaluation and tests have the most important role in the detection of patients for this procedure. According to our results, preoperative cystouretroscopy or CT alone have low sensitivity to determine the patients who may underwent prostate sparing cystectomy but evaluation of cystouretroscopy and CT together has higher positive predictive value. Decision of prostate sparing cystectomy is critical according to oncological results. We think that preoperative prostatic urethra biopsy and frozen section required for this critical decision in addition to preoperative cystouretroscopy and CT.