Weizer Alon Z, Shah Rajal B, Lee Cheryl T, Gilbert Scott M, Daignault Stephanie, Montie James E, Wood David P
Department of Urology, University of Michigan, Ann Arbor, MI 48109-0330, USA.
Urol Oncol. 2007 Nov-Dec;25(6):460-4. doi: 10.1016/j.urolonc.2006.09.016.
Prostate capsule sparing cystectomy has been performed in conjunction with orthotopic diversion to preserve sexual function and improve urinary control. Because concerns remain regarding incomplete surgical resection, we evaluated the risk of urothelial and prostate cancer in a series of patients undergoing radical cystoprostatectomy.
A total of 35 men undergoing radical cystoprostatectomy (August 2003-August 2005) had separate submission of the prostate peripheral zone/capsule from the prostate adenoma and bladder after surgery. These specimens were evaluated for bladder and prostate cancer grade, stage, and largest diameter of prostate cancer. Patient records were reviewed for demographic and medical information. Clinical variables were compared between patients with and without carcinoma involving the prostate using standard statistical software.
Of patients, 57% had cancer involving the prostate at radical cystoprostatectomy. There were 9 patients (26%) who had urothelial carcinoma involving the prostate; only prostatic urethral biopsy identified these patients before radical cystoprostatectomy. Prostate adenocarcinoma was evident in 16 of 35 (47%) patients, with a majority involving the prostate peripheral zone/capsule (43%). There were 4 patients (11%) who had clinically significant prostate cancer (Gleason sum >6 or tumor volume >0.5 cm(3)). Patients with prostate cancer were significantly older than patients without prostate cancer (P = 0.01).
No clinical variable can confidently predict patients with prostate cancer involving the prostate. Because a majority of patients undergoing radical cystoprostatectomy have cancer involving their prostate, preoperative evaluation with prostatic urethral and prostate biopsy may be useful to guide patient selection for prostate capsule sparing cystectomy.
保留前列腺包膜的膀胱切除术已与原位改道联合进行，以保留性功能并改善尿控。由于对手术切除不完全仍存在担忧，我们评估了一系列接受根治性膀胱前列腺切除术患者发生尿路上皮癌和前列腺癌的风险。
共有35名男性在2003年8月至2005年8月期间接受了根治性膀胱前列腺切除术，术后将前列腺外周带/包膜与前列腺腺瘤及膀胱分别送检。对这些标本进行膀胱和前列腺癌的分级、分期以及前列腺癌最大直径的评估。查阅患者记录以获取人口统计学和医学信息。使用标准统计软件比较有或无前列腺癌累及的患者之间的临床变量。
在接受根治性膀胱前列腺切除术的患者中，57%有前列腺癌累及。有9名患者（26%）发生了累及前列腺的尿路上皮癌；只有前列腺尿道活检在根治性膀胱前列腺切除术之前识别出了这些患者。35名患者中有16名（47%）有前列腺腺癌，其中大多数累及前列腺外周带/包膜（43%）。有4名患者（11%）患有具有临床意义的前列腺癌（Gleason评分总和>6或肿瘤体积>0.5 cm³）。有前列腺癌的患者比无前列腺癌的患者年龄显著更大（P = 0.01）。
没有临床变量能够可靠地预测有前列腺癌累及的患者。由于大多数接受根治性膀胱前列腺切除术的患者有前列腺癌累及，术前进行前列腺尿道和前列腺活检评估可能有助于指导选择保留前列腺包膜的膀胱切除术的患者。
