Incidental prostate cancer in patients with radical cystectomy for bladder cancer.

Abstract

225 Background: Radical cystectomy is the gold standard surgical treatment for invasive bladder cancer. Prostate adenocarcinoma is often found incidentally in the cystoprostatectomy specimen. The clinical significance of this type of cancer has not been well characterized. We reviewed the cohort of male patients with bladder cancer who underwent radical cystectomy and found to have incidental prostate adenocarcinoma. Methods: 1,964 patients with primary transitional cell carcinoma of bladder underwent radical cystectomy between 1971 and 2008 with a median follow-up of 12.1 yrs (0.1-36) at USC. 1553 of them were male (79%) and 559 (36%) had incidental pathologic prostate adenocarcinoma (PC-group). Prostate and bladder cancer characteristics, recurrence and overall survival (OS) in the cohort of PC-group are reviewed. Results: Median age in the PC-group was 69 yo (35-92). The incidental PC was organ confined (OC) in 527 patients (94%). 32 (6%) had non-OC prostate cancer, treated by adjuvant radiation (5), hormone ablation (3) with a median follow-up of 3.9 yrs (0.1-16). Median pre-op PSA was 1.66 (0.01-83) in PC-group and 1.31 (0.01-33.2) in non-PC group. Gleason score was ≤ 6 in 458 (82%), 7 in 78 (14%) and ≥ 8 in 12 (2%) cases. Reviewing bladder cancer in the PC vs. non-PC group, 84 and 83% had high-grade cancer, 63 and 58% had associated CIS, 41 and 36% had multifocal disease and 29 and 27% had LVI respectively (P > 0.05). Incidental PC did not have significant effect on recurrence (P=0.3) and OS (P=0.4) after cystectomy for bladder urothelial cancer. No patient died of PC. 5-year OS rate was 60 ± 2% in both PC and non-PC groups. 10-year OS rate was also comparable at 42 ± 2% in PC and 44 ± 2% in non-PC-group. Conclusions: Incidental prostate adenocarcinoma is reported in more than one third of patients who undergo radical cystectomy for bladder cancer. It is organ confined in most of the cases and has no correlation with bladder cancer stage. Outcome of patients with incidental prostate adenocarcinoma at the time of radical cystectomy relies exclusively on the bladder cancer.