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Fredrik Liedberg - One of the best experts on this subject based on the ideXlab platform.
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The value of bladder mapping and Prostatic Urethra biopsies for detection of carcinoma in situ (CIS)
BJU international, 2011Co-Authors: Sigurdur Gudjonsson, Mats Bläckberg, Gunilla Chebil, Staffan Jahnson, Hans Olsson, Wiking Månsson, Pär-ola Bendahl, Fredrik LiedbergAbstract:Study Type - Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It is well known that CIS is a major risk factor for muscle-invasive bladder cancer and that this entity can be difficult to diagnose. Taking cold-cup mapping biopsies from different areas of the bladder (BMAP) is commonly used in patients at risk of harbouring CIS. The diagnostic accuracy of this approach has not been assessed until now. By using the CIS found in the cystoprostatectomy specimen as an indicator of the true occurrence of CIS and comparing that with the findings of BMAP, it is clear that the sensitivity of BMAP to detect CIS when present is low and that negative findings should be considered unreliable. OBJECTIVES: • To assess the value of bladder mapping and Prostatic Urethra biopsies for detection of urothelial carcinoma in situ (CIS). • CIS of the urinary bladder is a flat high-grade lesion of the mucosa associated with a significant risk of progression to muscle-invasive disease. CIS is difficult to identify on cystoscopy, and definite diagnosis requires histopathology. Traditionally, if CIS is suspected, multiple cold-cup biopsies are taken from the bladder mucosa, and resection biopsies are obtained from the Prostatic Urethra in males. This approach is often called bladder mapping (BMAP). The accuracy of BMAP as a diagnostic tool is not known. PATIENTS AND METHODS: • Male patients with bladder cancer scheduled for cystectomy underwent cold-cup bladder biopsies (sidewalls, posterior wall, dome, trigone), and resection biopsies were taken from the Prostatic Urethra. • After cystectomy, the surgical specimen was investigated in a standardised manner and subsequently compared with the BMAP biopsies for the presence of CIS. RESULTS: • The histopathology reports of 162 patients were analysed. CIS was detected in 46% of the cystoprostatectomy specimens, and multiple (≥2) CIS lesions were found in 30%. • BMAP (cold-cup bladder biopsies + resection biopsies from the Prostatic Urethra) provided sensitivity of 51% for any CIS, and 55% for multiple CIS lesions. The cold-cup biopsies for CIS in the bladder mucosa showed sensitivity and specificity of 46% and 89%, respectively. CONCLUSION: • Traditional cold-cup biopsies are unreliable for detecting CIS in bladder mucosa and negative findings must be interpreted with caution. (Less)
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Prospective study of transitional cell carcinoma in the Prostatic Urethra, and prostate in cystoprostatectomy specimen
Scandinavian journal of urology and nephrology, 2007Co-Authors: Fredrik Liedberg, Harald Anderson, Mats Bläckberg, Gunilla Chebil, Thomas Davidsson, Sigurdur Gudjonsson, Staffan Jahnson, Hans Olsson, Wiking MånssonAbstract:To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the Prostatic Urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the Prostatic Urethra and prostate and examine the sensitivity of preoperative loop biopsies from the Prostatic Urethra. Preoperatively, patients were investigated with cold cup biopsies from the bladder and transUrethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. The incidence of TCC in the Prostatic Urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette-Guérin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the Prostatic Urethra/prostate. Cis, multifocal Cis (> or = 2 locations) and tumour location in the trigone were significantly more common in cystectomy specimens with TCC in the Prostatic Urethra and prostate: 21/50 (42%) vs 32/125 (26%), p=0.045; 20/50 (40%) vs 27/125 (22%), p=0.023; and 20/50 (40%) vs 26/125 (21%), p=0.01, respectively. Preoperative resectional biopsies from the Prostatic Urethra in the 154 patients analysed identified 31/47 (66%) of patients with TCC in the Prostatic Urethra/prostate, with a specificity of 89%. The detection of stromal-invasive and non-stromal involvement was similar: 66% and 65%, respectively. The incidence of TCC in the Prostatic Urethra and prostate was 29% (50/175) in the cystoprostatectomy specimen. Preoperative biopsies from the Prostatic Urethra identified 66% of patients with such tumour growth. Our findings suggest that preoperative cold cup mapping biopsies of the bladder for detection of Cis add little extra information with regard to the risk of TCC in the Prostatic Urethra and prostate.
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Urothelial carcinoma in the Prostatic Urethra and prostate: current controversies
Expert review of anticancer therapy, 2007Co-Authors: Fredrik Liedberg, Gunilla Chebil, Wiking MånssonAbstract:We reviewed the literature on urothelial carcinoma in the Prostatic Urethra and prostate. We concluded that the incidence of urothelial carcinoma in the Prostatic Urethra and prostate is probably underestimated. This fact warrants thorough follow-up of patients with high-risk bladder cancers and also whole-mount examination of the prostate after cystectomy to recognize the true incidence and extent of such tumor involvement. Resectoscope loop biopsy is the method of choice to detect urothelial carcinoma in the Prostatic Urethra/prostate and such biopsies should include the area around the verumontanum to ensure optimal sensitivity. Carcinoma in situ in the Prostatic Urethra should be treated with intravesical Bacillus Calmette-Guerin and a transUrethral resection of the prostate prior to that treatment might increase the contact of Bacillus Calmette-Guerin with the Prostatic Urethra, improve staging and in itself treat the Prostatic involvement. Conservative treatment of carcinoma in situ in the Prostatic ducts is an option, although radical surgery is probably best for treating extensive intraductal involvement, since data on the former strategy are inconclusive. Patients with stromal invasion should undergo radical surgery. It is necessary to take the route of Prostatic involvement into account when estimating prognosis in each individual patient, since contiguous growth into the prostate is associated with worse prognosis. Prospective studies using a whole-mount technique to investigate the prostate are needed to clarify both the role of different routes of prostate invasion and the prognostic significance of different degrees of prostate invasion. At cystectomy, when urothelial carcinoma is present in the Prostatic Urethra and/or prostate, it is necessary to balance the risk of Urethral recurrence and decreased sexual function against opinion and expectations expressed by the patient during preoperative counseling regarding urinary diversion and primary urethrectomy.
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prospective study of transitional cell carcinoma in the Prostatic Urethra and prostate in cystoprostatectomy specimen
Scandinavian Journal of Urology and Nephrology, 2007Co-Authors: Fredrik Liedberg, Harald Anderson, Mats Bläckberg, Gunilla Chebil, Thomas Davidsson, Sigurdur Gudjonsson, Staffan Jahnson, Hans Olsson, Wiking MånssonAbstract:Objectives. To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the Prostatic Urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the Prostatic Urethra and prostate and examine the sensitivity of preoperative loop biopsies from the Prostatic Urethra. Material and methods. Preoperatively, patients were investigated with cold cup biopsies from the bladder and transUrethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. Results. The incidence of TCC in the Prostatic Urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette–Guerin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the Prostatic Urethra/prostate. Cis, multifocal Cis (≥2 locations) and tumour...
Wiking Månsson - One of the best experts on this subject based on the ideXlab platform.
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The value of bladder mapping and Prostatic Urethra biopsies for detection of carcinoma in situ (CIS)
BJU international, 2011Co-Authors: Sigurdur Gudjonsson, Mats Bläckberg, Gunilla Chebil, Staffan Jahnson, Hans Olsson, Wiking Månsson, Pär-ola Bendahl, Fredrik LiedbergAbstract:Study Type - Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It is well known that CIS is a major risk factor for muscle-invasive bladder cancer and that this entity can be difficult to diagnose. Taking cold-cup mapping biopsies from different areas of the bladder (BMAP) is commonly used in patients at risk of harbouring CIS. The diagnostic accuracy of this approach has not been assessed until now. By using the CIS found in the cystoprostatectomy specimen as an indicator of the true occurrence of CIS and comparing that with the findings of BMAP, it is clear that the sensitivity of BMAP to detect CIS when present is low and that negative findings should be considered unreliable. OBJECTIVES: • To assess the value of bladder mapping and Prostatic Urethra biopsies for detection of urothelial carcinoma in situ (CIS). • CIS of the urinary bladder is a flat high-grade lesion of the mucosa associated with a significant risk of progression to muscle-invasive disease. CIS is difficult to identify on cystoscopy, and definite diagnosis requires histopathology. Traditionally, if CIS is suspected, multiple cold-cup biopsies are taken from the bladder mucosa, and resection biopsies are obtained from the Prostatic Urethra in males. This approach is often called bladder mapping (BMAP). The accuracy of BMAP as a diagnostic tool is not known. PATIENTS AND METHODS: • Male patients with bladder cancer scheduled for cystectomy underwent cold-cup bladder biopsies (sidewalls, posterior wall, dome, trigone), and resection biopsies were taken from the Prostatic Urethra. • After cystectomy, the surgical specimen was investigated in a standardised manner and subsequently compared with the BMAP biopsies for the presence of CIS. RESULTS: • The histopathology reports of 162 patients were analysed. CIS was detected in 46% of the cystoprostatectomy specimens, and multiple (≥2) CIS lesions were found in 30%. • BMAP (cold-cup bladder biopsies + resection biopsies from the Prostatic Urethra) provided sensitivity of 51% for any CIS, and 55% for multiple CIS lesions. The cold-cup biopsies for CIS in the bladder mucosa showed sensitivity and specificity of 46% and 89%, respectively. CONCLUSION: • Traditional cold-cup biopsies are unreliable for detecting CIS in bladder mucosa and negative findings must be interpreted with caution. (Less)
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Prospective study of transitional cell carcinoma in the Prostatic Urethra, and prostate in cystoprostatectomy specimen
Scandinavian journal of urology and nephrology, 2007Co-Authors: Fredrik Liedberg, Harald Anderson, Mats Bläckberg, Gunilla Chebil, Thomas Davidsson, Sigurdur Gudjonsson, Staffan Jahnson, Hans Olsson, Wiking MånssonAbstract:To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the Prostatic Urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the Prostatic Urethra and prostate and examine the sensitivity of preoperative loop biopsies from the Prostatic Urethra. Preoperatively, patients were investigated with cold cup biopsies from the bladder and transUrethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. The incidence of TCC in the Prostatic Urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette-Guérin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the Prostatic Urethra/prostate. Cis, multifocal Cis (> or = 2 locations) and tumour location in the trigone were significantly more common in cystectomy specimens with TCC in the Prostatic Urethra and prostate: 21/50 (42%) vs 32/125 (26%), p=0.045; 20/50 (40%) vs 27/125 (22%), p=0.023; and 20/50 (40%) vs 26/125 (21%), p=0.01, respectively. Preoperative resectional biopsies from the Prostatic Urethra in the 154 patients analysed identified 31/47 (66%) of patients with TCC in the Prostatic Urethra/prostate, with a specificity of 89%. The detection of stromal-invasive and non-stromal involvement was similar: 66% and 65%, respectively. The incidence of TCC in the Prostatic Urethra and prostate was 29% (50/175) in the cystoprostatectomy specimen. Preoperative biopsies from the Prostatic Urethra identified 66% of patients with such tumour growth. Our findings suggest that preoperative cold cup mapping biopsies of the bladder for detection of Cis add little extra information with regard to the risk of TCC in the Prostatic Urethra and prostate.
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Urothelial carcinoma in the Prostatic Urethra and prostate: current controversies
Expert review of anticancer therapy, 2007Co-Authors: Fredrik Liedberg, Gunilla Chebil, Wiking MånssonAbstract:We reviewed the literature on urothelial carcinoma in the Prostatic Urethra and prostate. We concluded that the incidence of urothelial carcinoma in the Prostatic Urethra and prostate is probably underestimated. This fact warrants thorough follow-up of patients with high-risk bladder cancers and also whole-mount examination of the prostate after cystectomy to recognize the true incidence and extent of such tumor involvement. Resectoscope loop biopsy is the method of choice to detect urothelial carcinoma in the Prostatic Urethra/prostate and such biopsies should include the area around the verumontanum to ensure optimal sensitivity. Carcinoma in situ in the Prostatic Urethra should be treated with intravesical Bacillus Calmette-Guerin and a transUrethral resection of the prostate prior to that treatment might increase the contact of Bacillus Calmette-Guerin with the Prostatic Urethra, improve staging and in itself treat the Prostatic involvement. Conservative treatment of carcinoma in situ in the Prostatic ducts is an option, although radical surgery is probably best for treating extensive intraductal involvement, since data on the former strategy are inconclusive. Patients with stromal invasion should undergo radical surgery. It is necessary to take the route of Prostatic involvement into account when estimating prognosis in each individual patient, since contiguous growth into the prostate is associated with worse prognosis. Prospective studies using a whole-mount technique to investigate the prostate are needed to clarify both the role of different routes of prostate invasion and the prognostic significance of different degrees of prostate invasion. At cystectomy, when urothelial carcinoma is present in the Prostatic Urethra and/or prostate, it is necessary to balance the risk of Urethral recurrence and decreased sexual function against opinion and expectations expressed by the patient during preoperative counseling regarding urinary diversion and primary urethrectomy.
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prospective study of transitional cell carcinoma in the Prostatic Urethra and prostate in cystoprostatectomy specimen
Scandinavian Journal of Urology and Nephrology, 2007Co-Authors: Fredrik Liedberg, Harald Anderson, Mats Bläckberg, Gunilla Chebil, Thomas Davidsson, Sigurdur Gudjonsson, Staffan Jahnson, Hans Olsson, Wiking MånssonAbstract:Objectives. To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the Prostatic Urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the Prostatic Urethra and prostate and examine the sensitivity of preoperative loop biopsies from the Prostatic Urethra. Material and methods. Preoperatively, patients were investigated with cold cup biopsies from the bladder and transUrethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. Results. The incidence of TCC in the Prostatic Urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette–Guerin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the Prostatic Urethra/prostate. Cis, multifocal Cis (≥2 locations) and tumour...
J. Vicente - One of the best experts on this subject based on the ideXlab platform.
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in situ transitional cell carcinoma involvement of Prostatic Urethra bacillus calmette guerin therapy without previous transUrethral resection of the prostate
Urology, 1996Co-Authors: Juan Palou, B. Xavier, M. Montlleó, P Laguna, J. VicenteAbstract:Abstract Objectives Bacillus Calmette-Guerin (BCG) has demonstrated both the efficacy in patients with carcinoma in situ (CIS) of the bladder and the penetration in the prostate (granulomas) after endovesical treatment. We treated patients with CIS of the Prostatic Urethra with bladder instillations of BCG without previous transUrethral resection to assess the local therapeutic effect. Methods Eighteen patients with CIS of the Prostatic Urethra (15 multifocal CIS and 15 associated to superficial bladder carcinoma) were treated with endovesical instillations of 81 mg of BCG Connaught weekly for 6 weeks. Results After a mean follow-up of 31 months, 14 of 18 patients had complete response, 3 had progression (2 in the prostate and 1 in the bladder); diffuse CIS of the bladder persisted in 1 patient. Three patients required cystectomy and 1 underwent palliative transUrethral resection. Fifteen patients are alive with no evidence of disease, 2 patients died due to progression of the disease, and 1 is alive with tumor. Conclusions The presence of CIS in the Prostatic Urethra can be managed with endovesical BCG as initial treatment with fairly good success. There is no need for transUrethral resection, even though a loop biopsy may have to be obtained at the first control examination to make sure there is no stromal invasion.
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In situ transitional cell carcinoma involvement of Prostatic Urethra: bacillus Calmette-Guérin therapy without previous transUrethral resection of the prostate.
Urology, 1996Co-Authors: Juan Palou, B. Xavier, Laguna P, M. Montlleó, J. VicenteAbstract:Bacillus Calmette-Guérin (BCG) has demonstrated both the efficacy in patients with carcinoma in situ (CIS) of the bladder and the penetration in the prostate (granulomas) after endovesical treatment. We treated patients with CIS of the Prostatic Urethra with bladder instillations of BCG without previous transUrethral resection to assess the local therapeutic effect. Eighteen patients with CIS of the Prostatic Urethra (15 multifocal CIS and 15 associated to superficial bladder carcinoma) were treated with endovesical instillations of 81 mg of BCG Connaught weekly for 6 weeks. After a mean follow-up of 31 months, 14 of 18 patients had complete response, 3 had progression (2 in the prostate and 1 in the bladder); diffuse CIS of the bladder persisted in 1 patient. Three patients required cystectomy and 1 underwent palliative transUrethral resection. Fifteen patients are alive with no evidence of disease, 2 patients died due to progression of the disease, and 1 is alive with tumor. The presence of CIS in the Prostatic Urethra can be managed with endovesical BCG as initial treatment with fairly good success. There is no need for transUrethral resection, even though a loop biopsy may have to be obtained at the first control examination to make sure there is no stromal invasion.
Calabuig C - One of the best experts on this subject based on the ideXlab platform.
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Recurrence of superficial bladder tumors in Prostatic Urethra
European urology, 1991Co-Authors: Eduardo Solsona, Inmaculada Iborra, J.v. Ricos, J.l. Monros, R. Dumont, Juan Casanova, Calabuig CAbstract:Of our 276 patients with superficial bladder carcinoma, 242 were male, and 36 of these had recurrence in Prostatic Urethra, 26 with macroscopic tumors, and 10 with tumors in situ (TIS). These recurrences represent an incidence of 13.3%, with an average follow-up of 34.3 months. When the Urethral tumor was limited to the mucosa, we chose conservative therapy, and the patients entered a random program with Mitomycin or Adriamycin administered endovesically. With this program, we could control the disease in 59.3% of the patients. However, 22.2% of them had recurrence with Prostatic stromal infiltration, so that we performed a more exhaustive exploration of the prostate, taking biopsies not only at the 5 and 7 o'clock positions, but also making a wider resection in order to find the incipient infiltration of the Prostatic stroma, and trying to avoid a possible understaging. When the Urethral tumor had infiltrated the Prostatic stroma, we performed cystoprostatourethrectomy, getting a survival rate free of disease of 40%. An association with vesical TIS was detected in 61.1% of these patients, with terminal ureteral tumor in 8.3% and with the anterior Urethra in 11.1%, showing the diffuse pattern of the disease. We conclude that when recurrence of Prostatic Urethra is present, it is necessary to monitor the whole urothelium during follow-up.
Faouzi Mosbah - One of the best experts on this subject based on the ideXlab platform.
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tumor recurrence in Prostatic Urethra following simultaneous resection of bladder tumor and prostate a comparative retrospective study
Urology, 2010Co-Authors: Mehdi Jaidane, Tawfik Bouicha, A. Slama, Wissem Hmida, A. Hidoussi, Nabil Ben Sorba, Faouzi MosbahAbstract:OBJECTIVES To evaluate the effect on the oncological outcomes and recurrences at the Prostatic Urethra of simultaneous transUrethral resection of bladder tumor (TURBT) and benign Prostatic hyperplasia (TURP). METHODS The records of 85 men (group 1) who had undergone simultaneous TURBT and TURP at our clinic between 1986 and 2006 and fulfilled the inclusion criteria were retrospectively analyzed and compared with those of 85 men (group 2) who had undergone TURBT only during the same period. Clinicopathologic parameters, recurrence and progression rates, and recurrence rates in the bladder neck and Prostatic Urethra were determined and compared. RESULTS There were no statistically significant differences in clinicopathologic parameters between the 2 groups. At a mean follow-up of 35.2 and 33.1 months in groups 1 and 2, respectively, only 1 patient developed recurrence in Prostatic Urethra or bladder neck in each group. There were no statistically significant differences between the 2 groups in follow-up time, recurrence, progression or recurrence in the Prostatic Urethra, and bladder neck. CONCLUSIONS According to our results, simultaneous transUrethral TURP and TURBT can be safely performed without increasing the risk of tumor recurrence in the Prostatic Urethra.
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Tumor recurrence in Prostatic Urethra following simultaneous resection of bladder tumor and prostate: a comparative retrospective study.
Urology, 2009Co-Authors: Mehdi Jaidane, Tawfik Bouicha, A. Slama, Wissem Hmida, A. Hidoussi, Nabil Ben Sorba, Faouzi MosbahAbstract:To evaluate the effect on the oncological outcomes and recurrences at the Prostatic Urethra of simultaneous transUrethral resection of bladder tumor (TURBT) and benign Prostatic hyperplasia (TURP). The records of 85 men (group 1) who had undergone simultaneous TURBT and TURP at our clinic between 1986 and 2006 and fulfilled the inclusion criteria were retrospectively analyzed and compared with those of 85 men (group 2) who had undergone TURBT only during the same period. Clinicopathologic parameters, recurrence and progression rates, and recurrence rates in the bladder neck and Prostatic Urethra were determined and compared. There were no statistically significant differences in clinicopathologic parameters between the 2 groups. At a mean follow-up of 35.2 and 33.1 months in groups 1 and 2, respectively, only 1 patient developed recurrence in Prostatic Urethra or bladder neck in each group. There were no statistically significant differences between the 2 groups in follow-up time, recurrence, progression or recurrence in the Prostatic Urethra, and bladder neck. According to our results, simultaneous transUrethral TURP and TURBT can be safely performed without increasing the risk of tumor recurrence in the Prostatic Urethra. Copyright (c) 2010 Elsevier Inc. All rights reserved.
