Incidental cancer of the prostate in patients with bladder urothelial carcinoma: comprehensive analysis of 1476 radical cystoprostatectomy specimens
Bruins HM, Djaladat H, Ahmadi H, Sherrod A, Cai J, Miranda G, Skinner EC, Daneshmand S. J Urol. 2013 May 23. pii: S0022-5347(13)04374-7. doi: 10.1016/j.juro.2013.05.034. [Epub ahead of print]

Source

Urology Resident, Radboud University Nijmegen Medical Center, Department of Urology, Nijmegen, The Netherlands.

Abstract

PURPOSE:

To determine the incidence, identify risk factors and determine the prognosis for incidental (clinically significant) prostate adenocarcinoma ((cs)PCA), prostatic urothelial carcinoma (PUC) and high-grade intra-epithelial neoplasia (HGPIN) in patients undergoing radical cystoprostatectomy for urothelial carcinoma of the bladder.

MATERIALS AND METHODS:

1476 patients without a history of PCA were analyzed. Incidences of (cs)PCA, PUC and HGPIN were determined in the total cohort and selected subgroups of patients. PUC was stratified in prostatic stroma (PUC-s) and prostatic urethra/duct (PUC-d) involvement. Univariate and multivariate analyses with multiple variables was performed. Recurrence-free survival (RFS) and overall survival (OS) rates were calculated. Median follow-up time was 13.2 years.

RESULTS:

753 (51.0%) of the 1476 patients had cancer involving the prostate. PCA, csPCA, PUC and HGPIN were present in 37.9%, 8.3%, 21.1% and 51.2% of the patients, respectively. Of the 312 (21.1%) patients with PUC, 163 (11.0%) patients had PUC-d only and 149 (10.1%) patients PUC-s. Risk factors for csPCA, PUC and HGPIN were identified, however, absence of these risk factors did not rule out their presence. Ten-year OS in patients with no-PUC, PUC-d and PUC-s was 47.1%, 43.3% and 21.7%, respectively (p < 0.001). None of the patients with csPCA died of prostate cancer.

CONCLUSIONS:

Over half of the patients undergoing radical cystoprostatectomy had cancer involving the prostate. Presence of PUC, in particular PUC-s, was associated with a worse prognosis, while csPCA did not alter survival. Pre-operative clinical and histopathologic risk factors are not reliable enough to accurately predict csPCA and/or PUC.