Is routine prostate biopsy needed prior to radical cystectomy?

223 Background: Prostate cancer (Pca) can be detected coincidentally in radical cystoprostatectomy (RCP) specimens for invasive bladder cancer. However, there is no uniformity of opinion on the need for prostate biopsy prior to RCP. We evaluated the necessity of preoperative prostate biopsy in invasive bladder cancer. Methods: From 1998 through 2009, of 300 patients undergoing radical cystectomy for muscle-invasive bladder cancer, 252 were male. Of these, we focused 212 patients, whose prostate-specific antigen (PSA) was measured preoperatively. Results: The median age was 66years and median follow-up period was 46 months. Thirty-five patients with PSA > 4.0 ng/mL or digital rectal examination (DRE) positive were all subjected to transrectal ultrasound (TRUS)-guided prostate biopsy (Pbx), and Pca was detected in 7 cases (20%) (Group I). Pca was also detected in 5 patients (17.9%) in RCP specimens of the 28 whose Pbx results were negative (Group II). Seventy-seven of the 177 patients with PSA ≤ 4.0ng/mL and DRE negative were underwent TRUS-guided Pbx, and Pca was detected in 1 case (1.3%) (Group III). Pca was detected in 10 patients (13.2%) out of the 76 whose Pbx results were negative (Group IV). Of the 177 patients, 100 underwent RCP without prostate biopsy, and Pca was detected in 16 cases (16%) (Group V). The average Gleason score of each Group, I, II, III, IV, and V were 6.6, 6.6, 7, 6.2, and 6.5, respectively. Tumor volumes of each Group, I, II, III, IV, and V were 3.12mL, 1.0mL, 0.65mL, 0.43mL, and 0.19mL, respectively. No patients experienced recurrence of PC, including biochemical recurrence. Conclusions: In cases with PSA ≤4.0 ng/mL and/or DRE negative, Pbx is not considered necessary. In cases with PSA > 4.0 ng/mL or DRE positive, Pca with an average volume of 3.12 mL were detected by Pbx in 20% of the patients. However, most are localized Pca, and postoperative recurrence of the Pca is not seen during follow-up period. The question of whether all patients in this group require Pbx needs to be examined through further stratification.