Pettus Joseph A, Al-Ahmadie Hikmat, Barocas Daniel A, Koppie Theresa M, Herr Harry, Donat S Machele, Dalbagni Guido, Reuter Victor E, Olgac Semra, Bochner Bernard H
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Eur Urol. 2008 Feb;53(2):370-5. doi: 10.1016/j.eururo.2007.07.031. Epub 2007 Jul 26.
To determine the incidence and location of prostate adenocarcinoma (PCa) and prostatic urothelial carcinoma (PUC) for patients undergoing radical cystoprostatectomy (RCP) for bladder cancer and to ascertain what preoperative information may be useful in predicting PUC or PCa in patients who may be candidates for prostate-sparing cystectomy.
Between 2001 and 2004, 235 consecutive patients underwent RCP and had whole-mount sections of the prostate. We reviewed our prospective radical cystectomy database for preoperative clinicopathological information associated with each patient. The bladder and whole-mount prostate sections were re-reviewed to determine the location and depth of the bladder tumor as well as the presence of any associated PCa and PUC.
We identified 113 of 235 (48%) and 77 of 235 (33%) men with PCa and PUC, respectively. Among patients with PCa, 33 (29%) had Gleason score of > or = 7, 25 (22%) had PCa tumor volume > 0.5 cc, and 15 (13%) had extracapsular extension. On multivariable analysis, only increasing age was significantly associated with PCa (odds ratio=1.3, p=0.046). Of the 77 with PUC, 28 (36%) had in situ disease only, while 49 (64%) had prostatic stromal invasion. Bladder tumor location in the trigone/bladder neck (p<0.001) and bladder carcinoma in situ (p<0.001) was strongly associated with PUC in the final specimen. Overall, 158 (67%) had either PCa or PUC in the prostate.
PCa and/or PUC is present in a majority of RCP specimens. Current preoperative staging and tumor characteristics are not adequate for determining who can safely be selected for prostate-sparing cystectomy.
确定因膀胱癌接受根治性膀胱前列腺切除术（RCP）的患者中前列腺腺癌（PCa）和前列腺尿路上皮癌（PUC）的发病率及位置，并确定哪些术前信息可能有助于预测适合保留前列腺的膀胱切除术的患者是否存在PUC或PCa。
2001年至2004年间，235例连续患者接受了RCP，并对前列腺进行了全层切片检查。我们回顾了前瞻性根治性膀胱切除术数据库，以获取与每位患者相关的术前临床病理信息。对膀胱和前列腺全层切片进行重新检查，以确定膀胱肿瘤的位置和深度以及是否存在任何相关的PCa和PUC。
我们分别在235例男性患者中确定了113例（48%）患有PCa，77例（33%）患有PUC。在患有PCa的患者中，33例（29%）Gleason评分≥7，25例（22%）PCa肿瘤体积>0.5 cc，15例（13%）有包膜外侵犯。多变量分析显示，只有年龄增加与PCa显著相关（优势比=1.3，p=0.046）。在77例患有PUC的患者中，28例（36%）仅患有原位疾病，而49例（64%）有前列腺基质侵犯。膀胱三角区/膀胱颈部的膀胱肿瘤位置（p<0.001）和膀胱原位癌（p<0.001）与最终标本中的PUC密切相关。总体而言，158例（67%）前列腺中存在PCa或PUC。
大多数RCP标本中存在PCa和/或PUC。目前的术前分期和肿瘤特征不足以确定哪些患者可以安全地选择保留前列腺的膀胱切除术。
