Cystoprostatectomy for effective palliation of symptomatic bladder invasion by prostate cancer

Purpose: We evaluated the palliative effect of cystoprostatectomy (CP) for palliating pelvic symptoms in patients with bladder invasion by prostate cancer. Materials and Methods: A total of 38 patients with clinical T4 prostate cancer, including primary tumors in 17 and recurrence following radiation therapy in 21, underwent palliative CP. Local symptoms, the need for surgical procedures to relieve obstruction, and chronic tube drainage for urinary obstruction before surgery and 3 months after surgery were compared. Average followup was 23 months. Time to local and systemic symptom recurrence, biochemical progression and metastasis was measured and disease specific survival was determined. Results: Local symptoms were reported by 34 patients (89%) before surgery and by 8 (21%) after surgery (p = 0.000). Preoperatively a total of 22 tubes were inserted in 13 patients to overcome urinary obstruction. Average indwelling tube duration was 6.9 months. A total of 24 transurethral prostatic tumor resections were performed in 11 patients. Following CP local symptoms were relieved permanently in 30 patients. The average interval between surgery and clinical systemic disease was 26 months. Median time to biochemical progression, metastasis and systemic symptoms was 8, 18 and 26 months, respectively. Median disease specific survival was 31 months (range 1.7 to 81.2). No perioperative deaths occurred. Rectal injuries occurred in 5 cases (13%) during surgery. Conclusions: Radical CP provides effective and durable palliation in patients with locally advanced prostate cancer. This procedure can be performed with acceptable morbidity in a select group of patients.