Pathological evaluation and quality of surgery in radical cystectomy in New South Wales, Australia.

BACKGROUND: Australian bladder cancer patients especially women are thought to have worse outcomes when compared to the other international series. The objective of this study was to assess the pathological pattern of primary bladder cancer at the time of radical cystectomy as well as assessing the quality of resection in New South Wales. METHOD: Pathology reports of radical cystectomy performed for primary bladder cancer were reviewed for a period of 10 years in a single major pathology centre servicing the state of New South Wales. RESULTS: Two hundred one specimens reviewed over 10 years. The tumour stage at the time of cystectomy was: CIS 29 (14%), Tx,a 5 (2%), T1 24 (12%), T2 49 (24%), T3 57 (28%) and T4 37 (18%). Lymphovascular invasion was seen in 94 (47%). Soft tissue margins were positive in 31 (15%), pelvic lymph node dissection was not performed in 64 (32%) of patients and only 32 (16%) of the patients had 10 or more lymph nodes harvested. No significant differences between men and women were noted in tumour stages, soft tissue positive margin rates and performance of pelvic lymph node dissection. Improving trends were noted in rates of negative soft tissue margins and the lymph node count during this period. CONCLUSION: Pattern of disease at the time of cystectomy was similar to the North American and European cohorts. Higher main specimen margin rates as well as lower lymph nodes retrieval rates were observed. No sex discrimination was observed. Further study is recommended to investigate the survival impact of this finding.

Cancer identified incidentally in the prostate following radical cystoprostatectomy: an Australian study.

BACKGROUND: The aim of this study was to determine the incidence and tumour characteristics of incidental prostatic cancer in Australian men with primary bladder cancer undergoing radical cystoprostatectomy (RCP). METHOD: Cystoprostatectomy specimens were reviewed for a 10-year period from a leading pathology centre in the state of New South Wales, Australia. Stamey classification was used to define significant prostate cancer. RESULTS: One hundred twenty-nine patients underwent RCP, 50 (39%) had prostatic adenocarcinoma, of which 35 (70%) were clinically significant. Apical involvement was seen in 10 (20%) of which 8 (16%) were clinically significant. High-grade intraepithelial neoplasia was seen in 27 (21%) and urothelial carcinoma or extension of bladder tumour was seen in 15 (12%) and 10 (8%) respectively. Bladder carcinoma in situ (CIS) was strongly associated with presence of urethral disease (P = 0.008). CONCLUSION: High rates of prostatic involvement with adenocarcinoma and as well as urothelial malignancy was detected in patients with primary bladder cancer undergoing cystoprostatectomy. Large proportions of prostate adenocarcinoma were clinically significant. Presence of bladder CIS was significantly associated with presence of prostatic urethral disease.