The study has been approved by the Silesian Medical University Ethics Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All patients gave their informed consent prior to their inclusion in the study.
In the period of time between December 1993 and March 2009 in the Department of Urology of the Medical University in Zabrze and the Urologic Department of the Provincial Hospital in Bielsko-Biała 320 patients with bladder cancer underwent cystoprostatectomy. 77 patients were subject of the current analysis. The patients were divided into two groups. The first one consisted of 52 patients with bladder cancer infiltrating prostate, while the second group consisted of 21 patients with co-existing prostate cancer. 4 patients were diagnosed with both co-existing prostate cancer and bladder cancer infiltrating prostate. These 4 patients were excluded from the research in the evaluation of survival. 21 patients from the second group accounted for 6.5% of all men with bladder cancer treated in the evaluated period of time in both centers.
None of the patients was subject to neoadjuvant therapy. In 14 (18.1%) patients orthotopic intestinal bladder was made, in 29 (37.6%) ureterocutaneostomies and in 34 (44.1%) ileal conduit. None of the analyzed patients died during the operation. According to the 2002 TNM classification the infiltration of prostate by urothelial bladder cancer means stage pT4a. Co-existing prostate cancer was considered insignificant if all of the features were observed: preoperative PSA < 10 ng/ml, Gleason score < 7, cancer lesion less than 0,5 ml and stage pT2 (organ-confined). Whole-mount sectioning of the prostate was conducted by 2 pathologists.
Patients after the surgery were monitored every 3 months during first year, for another 2 years - every 6 months and once a year 3 years after the surgery. Control tests included creatinine concentration, electrolytes, PSA concentration, urine stasis in the upper urinary tract (ultrasonography), chest radiography and pelvic/abdominal CT once a year.
In all patients the following criteria were analyzed: age, cancer specific survival, the frequency of complications and deaths, local recurrences, positive surgical margins, distant metastases, adjuvant chemotherapy, number of lymph nodes dissected and creatinine concentration before and after the surgery. Biochemical recurrence of prostate cancer was diagnosed if two consecutive serum PSA tests exceeded the level of 0.2 ng/ml. Survival time was 0 - 181 months (on average: 75.2 months).
The statistical analysis was performed by means of Statistica Statsoft v. 8.0. For continuous variables U-Mann-Whitney test was used. For categorical variables the Chi-square test was applied. Kaplan-Meier curves were used for the evaluation of cancer-specific survival with log-rank test. Proportional hazard (Cox) regression model was used to assess the influence of stage (T), grade (G), positive nodes (N), positive surgical margin, adjuvant chemotherapy and coexisting prostate cancer or pT4a bladder cancer on cancer specific survival.