Pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer

To determine the incidence, characteristics and factors influencing local pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer. Seventy two radical cystectomies and orthotopic neobladder substitution were performed on 70 men and 2 women. Sixty nine patients had transitional cell carcinoma [TCC], 2 patients had squamous cell carcinoma [SCC] and one had rhabdomyosacrcoma. Seven patients with TCC received adjuvant chemotherapy; 6 for micro-nodal disease and one patient had open cystotomy. Median follow up was 36 months. Eight of the 72 patients [11%] developed pelvic recurrence, 6 patients with TCC, one patient with SCC and another with rhabdomyosarcoma. All recurrences developed within 12 months of cystectomy. None of the recurrences involved the uretero-ileal anastomosis. Of the 6 patients with TCC, 4 patients had P3bN+ GIII TCC with vascular invasion while 2 patients had P3aN+ GIII TCC tumors. In one patient with P3b NO GIII TCC the recurrence invaded the neobladder. Three of the 6 patients with TCC had received adjuvant chemotherapy, 2 for positive nodes and one for open cystotomy. Five patients with TCC received a combination of external beam radiation and chetherapy. Partial response was achieved and 3 died of their disease. The patient with SCC was treated with radiation and the patient with recurrent rhabdomyosarcoma, that also invaded the neobladder, had total pelvic extenteration. Both died of their disease. Neobladder tolerated adjuvant chemotherapy and radiation well. Pelvic recurrence following orthotopic neobladder substitution is comparable to other forms of urinary diversion. Factors influencing recurrence are high stage, high grade disease, positive nodes, bladder violation and vascular invasion. Local recurrence can invade the neobladder. Radiation and chemotherapy result in partial response with poor prognosis

effect of antibiotics on elevated serum prostate specific antigen in patients with urinary symptoms and negative digital rectal examination: a pilot study

Introduction and objectives 65-70% of patients with abnormal prostate specific antigen [PSA] do not have cancer on prostate needle biopsy. Prostate biopsy is a potentially morbid procedure. Prostatitis is commonly reported on needle biopsies. To cut down on the number of unnecessary prostate biopsies we evaluated the effect of antibiotic on PSA level in patients with lower urinary tract symptoms [LUTS], normal digital rectal examination [DRE], normal urinalysis and elevated PSA. Material and methods 48 selected patients with LUTS, normal DRE, normal urinalysis and elevated PSA [range 5.0-28.5 ng/ml], that usually will undergo prostate biopsy, received 2 weeks of Ciprofloxacin. An alpha-blocker was added if the patient was bothered. PSA was repeated and prostate biopsy was performed if PSA did not drop. Results 25/48 patients [52%] dropped their PSA [median of 42% drop], with 80% improvement in LUTS, were not biopsied. 23/48 patients [48%] did not drop their PSA, with 65% improvement in LUTS, were biopsied. 9/23 patients [39%] had prostate cancer. Conclusion Almost 50% of patients with LUTS, normal DRE and elevated PSA will drop their PSA following 2 weeks of Ciprofloxacin thus by avoiding prostate biopsy. This needs to be done in a very strict manner with careful follow-up of those patients dropping their PSA especially not to normal levels