The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre

Abstract

Introduction: Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. However, given the treatment related complications of compromised potency and continence with this procedure, prostate/sexuality sparing cystectomy in orthotopic neobladder candidates has emerged in an effort to minimize these quality of life concerns. Recent evidence suggests only a marginal functional benefit from these technical refinements. We sought to determine the incidence of occult prostate cancer and urothelial cancer of the prostate in cystoprostatectomy specimens conducted for muscle invasive bladder cancer. Methods: We retrospectively reviewed 83 male patients who underwent radical cystoprostatectomy for muscle invasive bladder cancer between April 2004 and March 2007. The median age of our study group was 71 years. Pathologic findings of prostate/urothelial cancer in the prostate were identified. Clinically significant prostate cancer was defined as Gleason score >6, tumour volume >0.5cc, extracapsular extension or perineural invasion. Results: Our review yielded a 30% (±10%, 0.95 CI) rate of prostate cancer, with 19% (± 8.5%, 0.95 CI) of total specimens being positive for clinically significant prostate cancer. Urothelial cancer in the prostate was identified in 16% (±8.5%, 0.95 CI) of patients, with an overlap with prostate cancer in 2 patients. The overall rate of an underlying cancer within the prostate of our cystoprostatectomy specimens was about 46% (±10.7%, 0.95 CI). Conclusion: These findings suggest that the oncological risk of leaving behind residual cancer may not justify the practice of prostatesparing cystectomies.

Left behind: The potential problem of residual cancer

“…1 In keeping with previous reports, the incidence of clinically significant prostate and urothelial cancer was 19% and 16%, respectively. While no long-term survival data are presented, the authors conclude that the incidence of cancer in the prostate may preclude prostatesparing cystectomy in men with urothelial cancer of the bladder.…”

Incidental prostate cancer in Asian men: High prevalence of incidental prostatic adenocarcinoma in Chinese patients undergoing radical cystoprostatectomy for treatment of bladder cancer and selection of candidates for prostate‐sparing cystectomy

“…High grade, high volume, or high stage prostatic adenocarcinoma (PCa) and prostatic UCa have profound effects on the oncological outcome. Candidates for prostate‐sparing cystectomy must be selected carefully to minimize the risk of overtreatment or undertreatment .…”

Synchronous and Metachronous Secondary Tumors of Bladder Cancer Patients

“…Ancak mesane kanserinin prostata yayılımı ve senkron prostat kanseri olasılığı işlem öncesinde bu patolojilerin ekartasyonunu zorunlu hale getirmektedir. Radikal sistoprostatektomi sonuçlarının değerlendirildiği bir çalışmada klinik olarak önemli prostat adenokarsinomu ile prostat THK birlikteliği %27 olarak raporlanmıştır (66). Bir diğer önemli sorunda prostat koruyucu yaklaşımlar sonrası doku planlarının kaybolması, periprostatik enflamasyon ve fibrotik değişiklikler nedeniyle gelecekteki cerrahilerin daha zor olabileceğidir (66).…”

“…Radikal sistoprostatektomi sonuçlarının değerlendirildiği bir çalışmada klinik olarak önemli prostat adenokarsinomu ile prostat THK birlikteliği %27 olarak raporlanmıştır (66). Bir diğer önemli sorunda prostat koruyucu yaklaşımlar sonrası doku planlarının kaybolması, periprostatik enflamasyon ve fibrotik değişiklikler nedeniyle gelecekteki cerrahilerin daha zor olabileceğidir (66). Yaşı 60 yılın altında olan olgularda prostat kanser riski otopsi serilerindekine benzer iken, yaşı 60'ın üzerinde olan olgularda prostat kanseri insidansında keskin bir artış söz konusudur (67,68,69).…”