Utility of Transurethral Biopsy in Staging the Prostatic Urethra Prior to Radical Cystectomy.

Journal of Urology (White)

PubMedID: 25106902

Carl von Rundstedt F, Lerner SP, Godoy G, Amiel G, Wheeler TM, Truong LD, Shen SS. Utility of Transurethral Biopsy in Staging the Prostatic Urethra Prior to Radical Cystectomy. J Urol. 2015;193(1):58-63.
PURPOSE
To determine the likelihood that transurethral resection (TUR) biopsies of the prostatic urethra adjacent to the verumontanum will detect prostatic involvement of urothelial carcinoma (UC) in patients with bladder carcinoma.

MATERIAL AND METHODS
We compared the specimens of the pre-cystectomy TUR biopsy of the prostatic urethra with those of the matched radical cystoprostatectomy (RCP) in 272 patients with UC of the bladder. All prostates were evaluated by whole-mount step sections.

RESULTS
Prostatic involvement by UC was detected by TUR biopsy or RCP in 101 (37.1%) patients. TUR biopsy detected UC in 72 cases with a sensitivity of 71.3% and a specificity of 100%.The overall accuracy of the TUR biopsy for the detection of UC of the prostate was 89% (PPV 100%; NPV 86%). Invasive prostatic UC arising from the prostatic urethra was detected by TUR biopsy in 21 of 26 patients (81%) while prostatic CIS was detected in 39 of 52 cases (75%). Prostatic invasive UC resulting from transmural invasion of a bladder tumor was detected in 4 out of 15 patients by TUR biopsy.

CONCLUSION
Prostatic involvement by UC of the bladder was found in 37.1% of patients. The TUR Biopsy will miss most tumors resulting from transmural invasion of the bladder primary. CIS and invasive UC arising from the prostatic urethra will be detected in the majority of cases. A TUR biopsy of the prostatic urethra can complement staging and support clinical decision-making with respect to neoadjuvant chemotherapy and planning for an orthotopic neobladder.