The efficacy of transurethral biopsy for predicting the long-term clinicalimpact of prostatic invasive bladder cancer

Purpose: Involvement of the prostate by bladder cancer directly impacts sur vival, the risk of urethral recurrence, and treatment decisions concerning the timing of cystectomy and type of urinary diversion. Transurethral later omontanal loop biopsies are proposed as the most accurate method for evalua ting the prostatic urethra. Due to the potential clinical impact on individ uals we assessed its accuracy in a large cohort. Materials and Methods: Transurethral lateromontanal loop biopsies were perf ormed in 246 of 416 male patients at our institution between 1989 and 1997. The predictive value and sensitivity of transurethral biopsy, patterns of recurrence, survival and clinical impact were assessed in a cohort with 10 years of followup. Results: The sensitivity of transurethral biopsy for prostatic stromal inva sion was 53%, specificity was 77%, positive predictive value was 45% and ne gative predictive value was 82%. At the 10-year followup 129 patients (52.4 %) were dead, 85 (32%) had no evidence of disease, 16 (6.5%) had disease an d 16 (6.5%) were lost to followup. Mean followup in patients at risk for ur ethral recurrence was 61.7 months (range 0.56 to 134.1, median 56.8). Delay ed urethrectomy was performed in 15 of 235 cases (6.4%) at a mean of 15.2 m onths. Of the 246 patients 99 had prostatic disease at transurethral biopsy and/or cystectomy, including 11 (11%) with urethral recurrence. No patient required continent diversion takedown or died of urethral recurrence. Conclusions: Transurethral biopsy did not accurately determine prostatic in volvement. Prostatic involvement at biopsy or cystectomy translated into a higher risk of urethral recurrence. However, it did not have significant cl inical impact or affect survival and should not be an absolute contraindica tion to urethral diversion.