Implications of Definitive Prostate Cancer Therapy on Soft Tissue Margins and Survival in Patients Undergoing Radical Cystectomy for Bladder Urothelial Cancer

PURPOSE - We evaluated the possibility of an existing link between definitive prostate cancer treatment (DPCT) and its effect on positive soft tissue surgical margins (PSM) at the time of radical cystectomy (RC). A secondary objective was to determine if DPCT was associated with bladder cancer survival endpoints.

MATERIALS AND METHODS - There were 749 patients that underwent RC between 2000-2013. After excluding females and patients with non-urothelial histologies, 561 men were identified, of which 69 (12.3%) received single or multimodal DPCT. Univariate and multivariable logistic regressions were used to determine an association between clinical and pathologic features such as DTPC and PSM. Cox regression models and competing risk regressions were used to investigate the impact of DTPC and PSM on survival.

RESULTS - The median age for the male population was 70.0 years. There were 57 cases of PSM in our cohort of 561 men (10.2%). In men who underwent previous DPCT, 20/69 (29.0%) had PSM compared to 37/492 (7.5%) in men who never received DPCT (p<0.0001). Brachytherapy, radiotherapy, hormonal therapy, and radical prostatectomy significantly increased the rate of PSM. Brachytherapy (OR=5.8), radiotherapy (OR=2.7) and hormonal therapy (OR=5.1) remained independent predictors of PSM on multivariate analysis. PSM was associated with negative effects on recurrence-free survival (RFS), HR=3.1, cancer-specific survival (CSS), HR=4.1, and overall survival (OS), HR=2.8.

CONCLUSIONS - Patients with a history of DPCT are at increased risk of having PSM. PSM significantly impacts bladder cancer RFS, CSS and OS following RC. Careful patient counseling and surgical planning is crucial when managing patients undergoing a RC with a history of DPCT.

J Urol. 2015 Jun 5. pii: S0022-5347(15)04113-0. doi: 10.1016/j.juro.2015.05.091. [Epub ahead of print]

Luchey AM, Lin HY, Yue B, Agarwal G, Gilbert SM, Lockhart J, Poch MA, Pow-Sang JM, Spiess PE, Sexton WJ.


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