Introduction

Prostate Sparing cystectomy is a valid option for the treatment of patient with bladder cancer provided that strict selection criteria are used. Although that there is a uniform agreement on excluding patients with bladder neck tumors as well as patients with suspicious prostate that may harbor prostatic carcinoma, there has not been a standardized consensus on how to safely exclude them. Furthermore, the exclusion of other criteria such as carcinoma in situ, tumor characteristics and presence of preoperative hydronephrosis have not been clearly elucidated.

Methods

We retrospectively reviewed our laparoscopic/robotic assisted laparoscopic prostate sparing cystectomy series to evaluate our method of selecting patients.

Results

Between 2001 and 2011, 60 patients were treated with laparoscopic or robotic PSC for muscle invasive or recurrent non muscle invasive bladder cancer. Mean follow up time was 76.9 months ±33.3SD. When the preoperative PSA cut off value for biopsy was ? 4ng/dl; prostatic adenocarcinoma was detected on final pathology in 2 patients and arised de novo in 1 patient. When the value was lowered to 2.5ng/dl, no patient had incidental prostatic carcinoma and none developed de novo carcinoma. Distant/solitary carcinoma in situ was associated with more recurrences and so did preoperative hydronephrosis. Tumor grade, size and number were not associated with more recurrences.

Conclusions

The presence of any carcinoma in situ should be a contraindication to prostate sparing cystectomy. In addition to standard prostatic evaluation, a cut off PSA value of ? 2.5ng/dl for biopsy can eliminate any chance of harboring or developing a prostatic cancer.

Funding

none