The role of prostatic urethral biopsies as a staging tool for bladder cancer

Abstract

Objective:

To determine the incidence of prostatic urethral involvement in our patient population and how prostatic urethral biopsy correlates with final cystectomy pathology.

Patients and methods:

We conducted a retrospective review of prostatic urethral biopsies (PUB) performed between February 2008 and April 2012 in a single centre. PUB pathology was correlated with cystectomy pathology.

Results:

PUB was undergone by 172 patients with a median age of 70 years (range: 37–84 years): There were 35 (20%) patients having a positive PUB and 137 (80%) who were negative. Of the 94 patients who underwent cystectomy, we found that when the entire prostatic urethra was sectioned, 20 (21%) patients had cancer in the prostatic urethra. Cancer was found in 17 (77%) of 22 patients with a positive PUB and in three (4%) out of the 72 with a negative PUB (positive predictive value (PPV) 77%, negative predictive value (NPV) 96%, sensitivity 85% and specificity 93%). In all 94 patients, the prostatic apical margin was negative.

Conclusion:

Disease in the prostatic urethra affected 20% of patients, consistent with published data. Prostatic urethral apical margins were all negative. Intra-operative frozen section would have missed cancer in the 20 patients with prostatic urethral cancer, whereas PUB identified 17 (85%) of the 20 patients. These data confirm the value of using PUB before cystectomy, in our UK population.