First and second transurethral resections in intermediate-high risk bladder cancer: impact of the surgeon's volume on the recurrence and progression of primary bladder cancer.

BACKGROUND: We evaluated the impact of surgeon's volume on recurrence and progression in patients with newly diagnosed transitional cell carcinoma of the bladder after first transurethral resection (TUR) and second-TUR. METHODS: Between March 2005 and December 2012, 209 patients with intermediate-high risk primary bladder cancer who received second TUR within 2 to 6 weeks following the initial resection were prospectively included in a database and retrospectively analyzed. Surgeons were stratified into high-volume (>100 TUR) and low-volume (<100 TUR). Tumor recurrence and progression were analyzed respect to first and second-TUR and surgeon-volume. RESULTS: Of the 209 patients who underwent second-TUR, 57 (27.2%) had macroscopic tumors before resection, which correlated to tumors multiplicity. Stage and surgeon category were independent predictors of tumor recurrence, with a 5-year recurrence-free survival rate of 52.7% and 23.1% for high and low-volume surgeon, respectively (P<0.001). Stage and surgeon category at first and second-TUR were independent predictor of tumor progression, with a 5-year progression-free survival rate of 83.8% and 48.0% for high and low-volume surgeon, respectively (P<0.001). CONCLUSIONS: As for other major urological procedures, patients undergoing TUR performed by high volume surgeon may have better outcomes than patients operated by low-volume providers.

Radical prostatectomy in high-risk prostate cancer: incidence of specimen-confined disease (pT2-pT3a N0R0) and outcomes.

INTRODUCTION: Radical prostatectomy (RP) in patients with high-risk prostate cancer (PC) [prostate specific antigen (PSA) ≥ 20 ng/mL, and/or Gleason score ≥ 8, and/or cT3a disease] is considered an optional therapy, usually as a part of multimodal approach. Aim of the study is to evaluate the outcome of radical prostatectomy in case of specimen-confined (SC) disease and to compare it with patients with pathological locally-advanced disease. MATERIALS AND METHODS: Data from 176 consecutive patients with high-risk prostate cancer who underwent RP as initial therapy were analyzed, identifying subjects with specimen-confined disease (i.e. negative margins and negative lymph-nodes) in which RP was considered as monotherapy, and comparing oncological outcomes to patients with pathological non-SC disease, in which RP was considered as the first step of a multimodal approach. RESULTS: In high-risk prostate cancer, pathological report showed the presence of specimen-confined disease in 28.3% of cases. At univariate analysis, age and PSA correlate with the presence of SC disease at radical prostatectomy, while at multivariate analysis only PSA was a significant predictor of SC disease. At 5 years, Kaplan-Meier estimation of biochemical-free and cancer-specific survival was 56.2% and 97.7% vs 40.8% and 92.8% in specimen-confined disease and non-specimen-confined disease, respectively. CONCLUSIONS: High-risk prostate cancer presents challenges for uro-oncologists since standard treatment is still under debate. One third of patients will present with specimen-confined disease, for which radical prostatectomy represents the sole, initial curative therapy; RP as multimodal therapy in patients without SC disease permits excellent long-term oncological outcomes.