Login to Access Video or Poster Abstract: MP54-20
Sources of Funding: None

Introduction

To review the perioperative outcomes and histopathologic features of men undergoing radical cystectomy (RC) for invasive bladder cancer with a history of prostate cancer (PCa).

Methods

IRB approved, retrospective chart review was performed on 500 patients who underwent RC at a single tertiary center between 2001-2014. After excluding females, we identified a total of 90 patients with a history of PCa prior to RC. Of those, 57 patients underwent RC as definitive treatment for bladder cancer. Clinicopathologic data of both malignancies were collected as well as details regarding prostate cancer treatment. Peri-operative RC variables were recorded, including approach (open vs. robotic), type of diversion, estimated blood loss, lymph node yields, intra-operative and post-operative complications. Complications were defined using the standardized Clavien-Dindo classification. A genitourinary pathologist evaluated all pathologic specimens.

Results

57 patients at a median age was 77 years old underwent RC who had a history of PCa. Thirty five (61%) were treated with radiation prior to RC as either single or multimodal therapy for PCa. Compared to the non-irradiated group, patients in the irradiated group had higher stage (pT3/4) bladder disease (48.6% vs. 9.1% p=0.021), higher rates of lymphovascular invasion (37.1% vs. 2% p=0.006), and higher rates of variant bladder histology (42.9% vs. 13.6% p=0.021). There was no significant difference is GFR, ASA classification, BMI, smoking history, or utilization of neoadjuvant chemotherapy between the two groups. The majority of cystectomies were approached robotically, regardless of prior radiation history (72% overall vs. 71% in irradiated group p=0.915). History of prior radiation did not significantly change type of diversion performed, length of surgery, estimated blood loss, length of stay, or lymph node yield. Interestingly, there was a trend towards a lower rate of major complications with a robotic approach (p=0.057).

Conclusions

In men with a history of PCa, those treated with radiation had significantly higher stage disease, rates of lymphovascular invasion, and variant bladder cancer histology. Robotic assisted RC performed similarly to an open approach with respect to objective indicators of surgical quality with no increased risk of perioperative or postoperative complication across all types of diversions.

Funding

None