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]


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



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.


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.


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.


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.