Prostatic Urethral Biopsy Has Limited Usefulness in Counseling Patients Regarding Final Urethral Margin Status During Orthotopic Neobladder Reconstruction

Kassouf, Wassim; Spiess, Philippe E.; Brown, Gordon A.; Liu, Ping; Grossman, H. Barton; Dinney, Colin P.; Kamat, Ashish M.

doi:10.1016/j.juro.2008.03.037

Cited by 45 publications

(29 citation statements)

References 19 publications

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“…Ichihara et al reported in a series of 101 men with a pre‐RC transurethral prostate biopsy that biopsy achieved 85% sensitivity, 91% specificity, a 72% positive predictive value and 96% negative predictive value (NPV). Kassouf et al studied 245 cases with available pre‐RC biopsies and found a similarly high NPV of prostate biopsy (99%) but noted that the NPV of frozen section was 100%. Finally, Gaya et al recently evaluated 234 men who underwent pre‐RC prostate biopsy with either cold cup (49%) or transurethral (41%) biopsies.…”

Section: Resultsmentioning

confidence: 99%

Urethral recurrence after cystectomy: current preventative measures, diagnosis and management

et al. 2015

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To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included ‘urethral recurrence’, ‘cystectomy’ or ‘cystoprostatectomy’. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5‐year disease‐specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate‐ to high‐risk of recurrence to enable early detection of non‐invasive disease, which may be amenable to conservative therapy before urethrectomy.

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Section: Resultsmentioning

confidence: 99%

Urethral recurrence after cystectomy: current preventative measures, diagnosis and management

et al. 2015

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“…Furthermore, as there is a relatively low positive predictive value of prostatic urethral biopsy for predicting disease at the urethral margin at RC, collective data suggest that a FSA of the urethral margin should be performed for men scheduled for OBS [41]. Therefore, in the authors’ opinion a positive transurethral biopsy before cystectomy is not a reason to exclude a patient a priori from undergoing an orthotopic diversion.…”

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

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Context Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). Objective To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. Evidence acquisition A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. Evidence synthesis Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4–10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of ther distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26–155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. Conclusions SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. Patient summary Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4–10% of patients after radical removal of the bladder for bladder cancer. These patients’ prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.

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“…Hautmann has also shown that ONB can be safely carried out in patients with locally‐advanced disease . Patients with known prostate stromal involvement should not necessarily be excluded from undergoing an ONB if an intraoperative urethral frozen section shows no evidence of malignancy . In our series of pT4aN0M0 patients, 5‐year urethral RFS was 90% ± 7% in the orthotopic group versus 76% ± 10% in the heterotopic group ( P = 0.10; data not shown).…”

Section: Discussionmentioning

confidence: 71%

Radical cystectomy and orthotopic urinary diversion in male patients with pT4a urothelial bladder carcinoma: Oncological outcomes

et al. 2013

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Abbreviations & AcronymsAbstract: The aim of the present study was to evaluate the oncological outcomes of radical cystectomy followed by orthotopic urinary diversion in male patients with urothelial bladder carcinoma involving prostatic stroma (pT4a). A total of 1964 patients with urothelial bladder carcinoma who underwent cystectomy between 1971 and 2008 were retrospectively analyzed. Among them, male patients with pT4aN0M0 disease at cystectomy and orthotopic urinary diversion were identified and included in the analysis. Exclusion criteria were perioperative mortality and primary urethrectomy. The outcomes were urethral recurrence, local recurrence, recurrence-free survival and overall survival. Univariate and log-rank statistics were used to examine associations between variables and outcome. A total of 33 patients (1.7%) entered the study with a median age of 71 years. Median follow up was 4.8 years (range 0.1-21 years). A total of two urethral recurrences (6%) occurred at a median of 2.4 years after cystectomy. No patient had local recurrence. The 5-year recurrence-free survival and overall survival was 56% Ϯ 10% and 56% Ϯ 9%, respectively. The probability of urethral and local recurrence after orthotopic diversion in pT4a urothelial bladder carcinoma patients is low. Thus, orthotopic urinary diversion appears to be oncologically safe in this patient population.

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Prostatic Urethral Biopsy Has Limited Usefulness in Counseling Patients Regarding Final Urethral Margin Status During Orthotopic Neobladder Reconstruction

Cited by 45 publications

References 19 publications

Urethral recurrence after cystectomy: current preventative measures, diagnosis and management

Urethral recurrence after cystectomy: current preventative measures, diagnosis and management

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Radical cystectomy and orthotopic urinary diversion in male patients with pT4a urothelial bladder carcinoma: Oncological outcomes

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