Invasive bladder cancer: the role of bladder preserving therapy

To evaluate the reported outcomes of multimodality therapy with organ preservation in invasive bladder cancer and assess it as an alternative for radical cystectomy in selected cases. All the articles on multimodality therapy with organ preservation in invasive bladder cancer, published from 1974 to 2004, were reviewed and the results were compared with the outcome of radical cystectomy in cases with invasive bladder cancer. Multimodality therapy is transurethral resection of the bladder tumor [TURBT] combined with chemoradiation therapy. It yields a 36% to 48% 5-year survival rate, when the bladder is preserved, and an overall rate of 48% to 63%. This method takes a long time for treatment and is accompanied by significant morbidity and mortality. Cystectomy will be required in 34% to 45% of the patients, during the treatment course, and in 28%, repeat TURBT will be performed due to recurrence of superficial tumors. Organ preserving in multimodality therapy of invasive bladder cancer can have acceptable results in some special situation, provided that a close cooperation between urologist, radiotherapist, and oncologist exists. However, radical cystectomy is still considered the standard treatment for invasive bladder cancer

Changes in serum prostate-specific antigen level after prostatectomy in patients with benign prostatic hyperplasia

The goal of this study was to investigate the effect of transurethral resection of the prostate and open prostatectomy on the serum prostate-specific antigen [PSA] level in men with benign prostatic hyperplasia. Serum prostate-specific antigen levels were determined before and 6 months after operation in 86 patients with benign prostatic hyperplasia who had undergone transurethral resection of the prostate or open prostatectomy. We measured the prostate volume by means of transrectal ultrasonography and weighed the surgical specimen. Changes in serum PSA levels and their correlation with prostate volume and the resected prostate weight were evaluated. Of 86 patients, 45 underwent transurethral resection of the prostate and 41 underwent open prostatectomy. Mean PSA levels were reduced by 67.4% [range, 0.40 ng/mL to 7.60 ng/mL] in the patients who had undergone transurethral resection of the prostate and 80.7% [range, 1.00 ng/mL to 14.50 ng/mL] in the patients with open prostatectomy. Removal of 1g of prostate tissue reduced serum PSA levels by an average of 0.15 ng/mL in those who underwent transurethral resection of the prostate and 0.10 ng/mL in those treated with open prostatectomy [P = .018]. Forty patients [88.9%] in the group who underwent transurethral resection of the prostate and 39 [95.1%] in the open prostatectomy group exhibited a postoperative PSA level of less than 2.00 ng/mL [P = .20]. A modified reference range seems necessary for the screening of prostate cancer via PSA level in men who have undergone prostatectomy for benign prostatic hyperplasia