What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?

Complex case.

If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs.

As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata Memorial in India. Being randomized to RT vs no RT.

If indications for either or both, I would think it would be worth treating, as the toxicity profile is very reasonable based on modern post-prosta...

Currently, the indications for adjuvant RT for bladder cancer would be pT3/4 tumor with positive margins and/or positive nodes, but the data supporting the use of RT in this setting are not high level. This situation may be complicated by possible indications for adjuvant chemotherapy and/or immunotherapy for the bladder cancer, which may compromise the tolerance of adjuvant RT. Also, the type of urinary diversion procedure, cutaneous diversion vs neobladder for example, impacts the presence of ...

Agreed these are tough cases. In general, I'd rely on the modern early salvage data to just watch if PSA <0.2 even if the initial surgical intent wasn't definitive prostatectomy for prostate cancer.

Caveats of the ARTISTIC trials being low rates of higher risk features (e.g. GS 8-10 and N+) so as Dr. @Dr. First Last nicely summarized, there are certainly some indications for treatment.

The crux challenge is when and how to treat the fossa. Regardless of the urinary outlet, the fossa inevitably ...