Urologic Oncology: Seminars and Original Investigations
Original articleHigh incidence of clinically significant concomitant prostate cancer in patients undergoing radical cystectomy for bladder cancer: A 10-year single-center experience
Introduction
Bladder cancer (BC) and prostate cancer (PCa) are the most common genitourinary malignancies worldwide associated with significant morbidity and mortality [1].
Radical cystectomy (RC) with extended bilateral pelvic lymphadenectomy is currently the standard treatment for patients suffering from localized muscle-invasive or recurrent high-risk non–muscle-invasive BC according to the European Association of Urology (EAU) guidelines (www.uroweb.org).
Especially in younger men, there is a recent strong trend toward prostate or at least “prostate apex or capsule-sparing” techniques, whose clear advantages are the functional improvement of voiding and sexual function, whereas oncological outcomes have been reported not as inferior in comparison to standard RC [2].
However, one has to consider that “prostate-sparing” surgery techniques harbor still the risk of a prostate involvement from BC or even the existence of PCa as a second malignancy [3], [4], [5]. Furthermore, no exact consensus exists regarding which approach preserves function best, varying from “prostate-, capsule-, seminal-, and nerve-sparing” techniques [6]. Therefore, regarding the current knowledge, “prostate-sparing cystectomy” may be an option only in a subset of carefully selected patients with BC without primary involvement of the prostatic urethra and without known PCa.
Currently, only few studies analyzed the effect of PCa in RC specimens while most of them argue that PCa is insignificant in patients undergoing RC and that “prostate-sparing cystectomy” technique can be safely offered to patients with bladder-confined disease.
The aim of the present study was to analyze the PCa incidence, histology, and clinical significance, as well their implication for management in patients with advanced BC undergoing standard RC. In addition, we aimed to determinate the effect of PCa recurrence in this 10-year single-center analysis including 213 patients.
Section snippets
Patients and methods
The study was approved by the local ethics committee (study no. UN3532; 274/4.4 and AN2015-0085; 348/4.10).
We retrospectively analyzed 213 male consecutive patients who underwent standard RC including removal of the bladder, prostate, seminal vesicles, distal ureters, bilateral extended pelvic lymphadenectomy, and urinary diversion from January 2006 to December 2015 at our department. All patients met the European Association of Urology (EAU) criteria for cystectomy (www.uroweb.org), with
Results
We analyzed 213 male patients who underwent RC. Histology and pathology of BC specimens are demonstrated in Table 1.
Of 213 male patients, 113 patients (53.1%) were diagnosed with PCa in the RC specimen. Among them, all patients showed the histology of an acinar adenocarcinoma. None of our patients included in the study had a transrectal or perineal prostate biopsy before RC. Further, no prostate biopsies were performed as part of the transurethral resection of the prostate or bladder mapping.
Discussion
Concomitant PCa is a relatively common finding in RC specimens, however, strongly varying between different studies reporting incidences up to 60% [2], [3], [6], [7], [8], [9], [10], [11], [12], [13].
In the present study, we also retrospectively analyzed the incidence of incidental PCa in a large patient collective including 231 male patients undergoing RC for advanced BC in a single-center 10-year analysis of prospectively enrolled patients.
Thereby in more than 50% of RC specimens, PCa was
Conclusion
Concomitant PCa is occurring more than 50% of all RC specimens in men with a significant proportion having characteristics (GS, pathological stage) of clinically relevant disease. Adverse bladder histology (≥pT3) was found in 63.7% of patients with PCa being a potential risk factor for biochemical PSA recurrence.
Follow-up analyses after RC should include PSA measurements also in low-risk PCa as a considerable number of patients develop biochemical recurrence and metastases from PCa partly
Acknowledgments
The authors would like to thank Siegrid Amort for helpful contribution to this work. This study was supported by the Medical Research Foundation Tyrol (MFF Tirol, project number 273).
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