Urology · 2005
Risk assessment for occult malignancy in the prostate before radical cystectomy.
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Kefer John C, Voelzke Bryan B, Flanigan Robert C, Wojcik Eva M, Waters W Bedford, Campbell Steven C
Аннотация
OBJECTIVES: To assess our clinical ability to predict prostate involvement by transitional cell carcinoma (PI-TCC) or occult prostate cancer (CAP) in patients undergoing radical cystectomy (RCx).
METHODS: We retrospectively analyzed 70 male patients undergoing RCx for TCC of the bladder between 1995 and 2003, focusing on preoperative factors to predict PI-TCC or CAP.
RESULTS: Of 70 RCx patients, 30 (43%) had PI-TCC (14) or CAP (16). Risk factors for PI-TCC included carcinoma in situ, multifocal TCC, and bladder neck involvement (P <0.05 for all three analyses). All 14 patients with PI-TCC had one or more risk factors, and none of 40 patients without these risk factors had PI-TCC (P <0.001). Risk factors for CAP included elevated prostate-specific antigen level, abnormal results on digital rectal examination, and age more than 65 years. Of 16 patients with CAP, 14 had one or more of these risk factors (P <0.05). Sixteen of the seventy patients in this series (22.9%) had no risk factors for PI-TCC or CAP, and none of these had prostatic involvement with either malignancy (P <0.05).
CONCLUSIONS: Our findings suggest that a well-defined subset of patients undergoing RCx might be at low risk for malignancy in the prostate. However, further evaluation of these risk factors in a prospective setting will be required to substantiate these findings and guide clinical decision making in this controversial field.
METHODS: We retrospectively analyzed 70 male patients undergoing RCx for TCC of the bladder between 1995 and 2003, focusing on preoperative factors to predict PI-TCC or CAP.
RESULTS: Of 70 RCx patients, 30 (43%) had PI-TCC (14) or CAP (16). Risk factors for PI-TCC included carcinoma in situ, multifocal TCC, and bladder neck involvement (P <0.05 for all three analyses). All 14 patients with PI-TCC had one or more risk factors, and none of 40 patients without these risk factors had PI-TCC (P <0.001). Risk factors for CAP included elevated prostate-specific antigen level, abnormal results on digital rectal examination, and age more than 65 years. Of 16 patients with CAP, 14 had one or more of these risk factors (P <0.05). Sixteen of the seventy patients in this series (22.9%) had no risk factors for PI-TCC or CAP, and none of these had prostatic involvement with either malignancy (P <0.05).
CONCLUSIONS: Our findings suggest that a well-defined subset of patients undergoing RCx might be at low risk for malignancy in the prostate. However, further evaluation of these risk factors in a prospective setting will be required to substantiate these findings and guide clinical decision making in this controversial field.