Purpose: The standard treatment of high-grade, invasive bladder cancer is radical cystectomy. Prostate-sparing techniques have recently become an alternative surgical approach for the treatment of the disease. We review the literature regarding the oncologic and functional outcomes for prostate-sparing approaches.
Materials and methods: The literature pertaining to prostate-sparing cystectomy was reviewed. The oncologic issues of preserving the prostate in patients undergoing cystectomy for bladder cancer along with the functional outcomes were evaluated.
Results: There is a significant incidence of bladder and prostate cancer involving the prostate, and prostate apex in men requiring cystectomy for transitional cell carcinoma of the bladder at the time of surgery. This involvement of the prostate with cancer maybe difficult to determine preoperatively. Importantly, although prostate-sparing procedures provide good potency results, the functional outcomes following cystectomy and orthotopic diversion to the urethra are not significantly different, particularly regarding daytime continence. Lastly, several studies suggest the oncologic outcomes following prostate-sparing cystectomy may be compromised with this surgical approach.
Conclusions: The significant incidence of bladder and prostate cancer involving the prostate at the time of cystectomy, which is difficult to determine preoperatively, may preclude the general application of prostate-sparing techniques in most men requiring cystectomy. Concerns regarding the oncologic outcomes with prostate-sparing techniques, coupled with the excellent results seen with traditional radical cystectomy and orthotopic diversion, suggest that prostate-sparing procedure should be performed only in well-selected individuals.