Incidentally Detected Prostate Cancer in Cystoprostatectomy Specimens

Abstract

Objectives: Bladder and prostate cancers occur with increasing prevalence in the ageing population. Our study aims to quantify the incidence of prostate cancer in patients undergoing cystoprostatectomy for bladder cancer and assess the impact of that incidental prostate cancer on oncological outcome. Methods and Materials: We retrospectively reviewed the pathology reports of 128 men who underwent cystoprostatectomy for bladder cancer. Results: Twenty-three men (18%) were found to have incidental prostate cancer. All incidental prostate cancers were organ confined and 91% were well or moderately differentiated. At a mean follow-up of 55 months the prostate cancer-free survival was 96%. Conclusion: The incidence of prostate cancer in cystoprostatectomy specimens is high. When the prostate is removed completely the presence of incidental prostate cancer does not influence the overall oncological outcome.

Characterization of prostate cancer incidentally detected in radical cystoprostatectomy specimens from Japanese men with bladder cancer

“…Unsuspected prostate cancer in radical cystoprosatectomy specimens were shown to generally involve small lesions localized within the prostate [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The present study also confirmed this finding; that is, incidentally detected prostate cancer was regarded as having more favorable characteristics in terms of serum PSA, pathological stage, Gleason score, perineural invasion and capsular penetration than clinically detected prostate cancer.…”

“…In this series, incidental prostate cancers were found in 12.3% of cystoprostatectomy specimens, which was remarkably low compared with those in previous studies from Western countries; that is, when the outcomes of 18 studies summarized in Table 3 were combined, the proportion of incidental prostate cancer in Western countries appeared to be 28.0% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Considering the well-established finding that the incidence of latent prostate cancer in Japan is similar to that in Western countries [22], these outcomes suggest that different mechanisms are involved in the development of incidental and latent cancers in Japanese and Western men.…”

“…The present study also confirmed this finding; that is, incidentally detected prostate cancer was regarded as having more favorable characteristics in terms of serum PSA, pathological stage, Gleason score, perineural invasion and capsular penetration than clinically detected prostate cancer. Furthermore, in this series, 29.0% of incidental prostate cancers were judged to be insignificant cancer; however, various proportions of insignificant prostate cancer in cystoprostatectomy specimens were reported in previous studies, ranging from 7 to 60%, which may reflect several methodological differences among these studies, such as the definition of insignificant disease and sectioning interval of resected specimens [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. It is of interest to investigate the prognostic significance of incidental prostate cancer.…”

“…These latent cancers are usually small, well or moderately differentiated, and localized within the prostate. In general, the majority of prostate cancers detected in the prostate of cystoprostatectomy specimens from patients undergoing bladder cancer surgery have also been regarded as clinically insignificant disease [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Therefore, analyzing cystoprostatectomy specimens, which offer a unique opportunity to study the incidence and morphological features of incidental prostate cancer, would be an interesting approach to characterize differences between incidentally and clinically detected prostate cancers.…”

Incidental Prostate Cancer at the Time of Cystectomy: The Incidence and Clinicopathological Features in Chinese Patients

“…As Delongchamps et al mentioned, in patients with concomitant prostate cancer, the poor survival rate was due to the majority of advanced bladder tumors and the outcome would be probably similar as the patients without coexisting prostate cancer [36]. Other authors also have found the same results [17], [37]–[38]. In this case, another oncological problem would focus on whether incidental significant prostate cancer could affect the cancer specific survival of these patients.…”