Introduction

Prostate sparing cystectomy (PSC) is a controversial subject in the management of bladder cancer. Some authors believe it is a valid option in certain selected cases, while others believe that it carries significant risks. One of the arguments against sparing the prostate was the observation that it has unusually high rate of distant metastasis when compared to radical cystectomy. It was speculated that metastatic diffusion through prostatic veins can occur during endoscopic prostatic resection prior to surgery._x000D_ we aimed to evaluate retrospectively, whether the different approaches to the prostatic adenoma prior to prostate sparing cystectomy have an impact on the rate of metastasis._x000D_

Methods

Between October 1992 and December 2011, 160 cases with bladder cancer were treated with prostaste sparing cystectomy at our institution. Out of these; 100 patients (62.5%) had their prostate managed with TURP while 60 patients (37.5%) were managed by prostatic enucleation during cystectomy using Millin’s technique. A minimum of 5 years follow up was available.

Results

Mean patient age was 62 years for the TURP group and 60 years for the Millin’s group. Mean postoperative follow up available was 64 months and 78 months for TURP and Millin’s group respectively. Postoperative pathological stage for the TURP group was ? pT1N0 in 24% , pT2N0 in 40%, ? pT3N0 in 23% and N+ in 13% ; compared to the Millin’s group where the pathological stage was ? pT1N0 in 40 %, pT2N0 in 30%, ? pT3N0 in 22% and N+ in 8%. Overall survival rates at 5 years were 67% and 88% for the TURP and the Millin’s groups respectively. The 5 years recurrence free survival rates for the TURP group were 77% for pT2 N0 or less, 44% for pT3 N0 or greater and 22% for pN+ disease. Regarding the Millin’s group, the recurrence free survival rates were 86% for pT2 N0 or less, 75% for pT3 N0 or greater and 40% for pN+ disease. The local recurrence rates were 6.2 % and 11.7 % for the TURP and the Millin’s groups respectively, and the respective distant recurrence rate was 34% and 16.7% .( p?0.001)

Conclusions

These results further support previous suggestions that TURP may contribute to the dissemination of tumor cells in bladder cancer patients.

Funding

none