DOES PROSTATE TRANSITIONAL-CELL CARCINOMA PRELUDE ORTHOTOPIC BLADDER RECONSTRUCTION AFTER RADICAL CYSTOPROSTATECTOMY FOR BLADDER-CANCER

Purpose: We determined if urethral preservation and orthotopic bladder replacement in patients with transitional cell carcinoma within the p rostatic urethra or prostate placed these patients at risk for urethra l recurrence or death. Materials and Methods: The clinical course of a ll patients undergoing urethral preservation and orthotopic bladder re placement was reviewed. The urethra was sacrificed only if the distal prostatic urethral margin was positive for transitional cell carcinoma . The pathological T stage and the grade of the primary malignancy, lo cal recurrence, site of recurrence (urethral, pelvic, distant) and dea th were documented. Results: Of 81 patients 70 were evaluable (June 19 96) with a mean followup of 35 months. Of the 70 patients 48 were aliv e without evidence of disease for a mean of 38 months (range 8 to 107) and 5 died without evidence of disease. Eight of these 53 patients (1 5%) had prostatic involvement (carcinoma in situ in 6, intraductal car cinoma in 1 and stromal invasive transitional cell carcinoma in 1). Of the 70 patients 17 had disease recurrence (13 died of disease and 4 a re alive, 1 of whom had urethral recurrence without initial prostatic transitional cell carcinoma). Of the 17 patients (35%) 6 had transitio nal cell carcinoma prostatic involvement (carcinoma in situ in 4 and s tromal invasion in 2), and 5 of these 6 died, none with or of urethral recurrence but of the primary bladder pathology. Of these 5 patients 1 had stromal invasive transitional cell carcinoma of the prostate and experienced a bulbar urethra recurrence at 1 month and a pelvic recur rence at 3 months, and died at 5 months. Death was not secondary to th e urethral recurrence. Thus, of the 14 patients who had prostatic tran sitional cell carcinoma, only 1 had urethral recurrence (7%), and this recurrence did not present as the cause of death. Conclusions: The gu idelines for urethral resection can be relaxed, increasing the opportu nities for orthotopic reconstruction, without placing the patients at increased risk for death of transitional cell carcinoma.