Urothelial carcinoma (UC) of the bladder has a high recurrence rate. Non–muscle‐invasive bladder cancer (NMIBC) requires careful follow‐up after transurethral resection (TUR). Some cases of extravesical recurrence of UC have been reported following radical cystectomy or nephroureterectomy; however, few such cases following robot‐assisted radical prostatectomy (RARP) are known. A 77‐year‐old man presented to our hospital with high serum prostate‐specific antigen (PSA) levels and atypical urothelial cells. Prostate biopsy and photodynamic diagnosis (PDD)‐TURBT were performed. Pathological diagnoses were adenocarcinoma (Gleason score 3 + 4) of the prostate and UC (high grade, pT1 + Tis) of the bladder. Intravesical Bacillus Calmette–Guerin (BCG) was administered. One year after BCG therapy, examinations showed no evidence of UC recurrence; RARP was performed in another hospital on his will. Four months following RARP, elevated serum carbohydrate antigen 19‐9 (CA19‐9), palpable port‐site subcutaneous indurations, and intraperitoneal nodules were detected by blood test and positron emission tomography/computed tomography (PET/CT). The subcutaneous indurations were pathologically diagnosed as UC. Platinum‐based chemotherapy decreased the level of serum CA19‐9. Cancer progression with the elevation of serum CA19‐9 was observed during subsequent avelumab therapy, and enfortumab vedotin therapy was initiated. The patient died from cancer progression 30 months after extravesical recurrence of UC. RARP for patients with a past history of bladder tumor presents a risk of dissemination of UC due to urine leakage. Thorough examination for UC before RARP is recommended.
Kaneko et al. (Thu,) studied this question.