Prostate-Sparing Cystectomy Is Safe
Prostate-sparing cystectomy (PSC) for bladder cancer, a procedure aimed at preserving sexual function by leaving the prostate, seminal vesicles, and vasa deferentia intact, has long-term oncologic outcomes comparable to those of standard cystoprostatectomy (SC), data show. The key to the success of PSC, however, is careful patient selection, according to researchers.
Simon Horenblas, MD, of the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital in Amsterdam, and colleagues analyzed outcomes of PSC performed on 63 men. Inclusion criteria for PCS included an indication for cystectomy, motivation for preserving sexual function. Exclusion criteria included tumor in the bladder neck or prostatic urethra or the presence of prostate cancer (PCa). These patients were compared with 63 men who underwent SC.
The median follow-up was 56 months in the PSC group and 76 months in the SC group. In both groups, all patients had a minimum follow-up of one year, but 91% had more than two years of follow-up and 78% had more than three years of follow-up.
The five-year disease-specific survival rates were 66% and 64% in the PSC and SC groups, respectively, a nonsignificant difference between groups, Dr. Horenblas' group reported in BJU International (2009;104:1239-1243). The local recurrence rates were 7.9% and 16%, respectively, and the distant recurrence rates were 29% and 33%, respective. These differences were not statistically significant.
Subsequent PCa was detected in 3% of the PSC group; none of these patients died from the malignancy. In the SC group, final pathology revealed that 18% had PCa.
Information on erectile function was available for 55 of the 63 patients in the PSC group. Five patients could not be evaluated because of early death and three were not sexually active following the procedure. Erectile function was preserved in about 90% of the evaluable 55 patients.
“Although there were few patients in the present study,” the authors noted, “and those those treated with PSC were highly selected, we consider PSC for bladder cancer to be as safe as SC, provided that patients eligible for PSC are screened meticulously before surgery, focusing on the presence of occult prostate cancer and risk factors for recurrence in the prostatic urethra.”