The efficacy of transurethral biopsy for predicting the long-term clinical impact of prostatic invasive bladder cancer Journal Article
| Authors: | Donat, S. M.; Wei, D. C.; Mcguire, M. S.; Herr, H. W. |
| Article Title: | The efficacy of transurethral biopsy for predicting the long-term clinical impact of prostatic invasive bladder cancer |
| Abstract: | Purpose: Involvement of the prostate by bladder cancer directly impacts survival, the risk of urethral recurrence, and treatment decisions concerning the timing of cystectomy and type of urinary diversion. Transurethral lateromontanal loop biopsies are proposed as the most accurate method for evaluating the prostatic urethra. Due to the potential clinical impact on individuals we assessed its accuracy in a large cohort. Materials and Methods: Transurethral lateromontanal loop biopsies were performed 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 follow-up. Results: The sensitivity of transurethral biopsy for prostatic stromal invasion was 53%, specificity was 77%, positive predictive value was 45% and negative predictive value was 82%. At the 10-year follow-up 129 patients (52.4%) were dead, 85 (32%) had no evidence of disease, 16 (6.5%) had disease and 16 (6.5%) were lost to follow-up. Mean follow-up in patients at risk for urethral recurrence was 61.7 months (range 0.56 to 134.1, median 56.8). Delayed urethrectomy was performed in 15 of 235 cases (6.4%) at a mean of 15.2 months. 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 involvement. Prostatic involvement at biopsy or cystectomy translated into a higher risk of urethral recurrence. However, it did not have significant clinical impact or affect survival and should not be an absolute contraindication to urethral diversion. |
| Keywords: | adult; cancer survival; aged; aged, 80 and over; middle aged; survival rate; major clinical study; follow-up studies; sensitivity and specificity; bladder cancer; prediction; urinary bladder neoplasms; biopsy; prostate cancer; cancer invasion; prostatic neoplasms; prostate; prostate biopsy; cystectomy; urinary diversion; predictive value of tests; multivariate analysis; neoplasm invasiveness; bladder neoplasms; high risk population; transurethral resection; stroma cell; transitional cell carcinoma; urethra; urethral neoplasms; humans; prognosis; human; male; priority journal; article |
| Journal Title: | Journal of Urology |
| Volume: | 165 |
| Issue: | 5 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2001-05-01 |
| Start Page: | 1580 |
| End Page: | 1584 |
| Language: | English |
| PUBMED: | 11342921 |
| PROVIDER: | scopus |
| DOI: | 10.1016/S0022-5347(05)66352-5 |
| DOI/URL: | |
| Notes: | Export Date: 21 May 2015 -- Source: Scopus |
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