You have accessJournal of UrologyProstate Cancer: Detection and Screening VII1 Apr 2015MP86-17 CLINICALLY SIGNIFICANT INCIDENTAL PROSTATE CANCER DETECTED IN RADICAL CYSTOPROSTATECTOMY SPECIMENS Swar Shah, Soroush Bazaragani, Gus Miranda, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Swar ShahSwar Shah More articles by this author , Soroush BazaraganiSoroush Bazaragani More articles by this author , Gus MirandaGus Miranda More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While the focus of radical cystoprostatectomy (RC) is usually a bladder-primary malignancy, incidental prostate cancer is a common finding during pathological examination of the surgical specimen. While mostly clinically insignificant and generally minimally monitored, we sought to characterize clinically significant prostate cancer (csPCA), which may require closer monitoring. Herein, we evaluate the role of prostate specific antigen (PSA) in monitoring csPCA diagnosed at the time of RC. METHODS Using and IRB approved prospective database, we identified 1451 patients who underwent RC between 2003 and 2014 at our institution. Clinically significant prostate cancer was defined as Gleason score ≥7, extra prostatic extension, seminal vesicle involvement, positive surgical margin, and lymph node involvement. PSA values were recorded. In patients with evidence of a biochemical recurrence, complete follow up was obtained. Patients were diagnosed with recurrence based on PSA values or findings on cross sectional imaging. RESULTS We identified a total of 107 patients with csPCA diagnosed at the time of RC, of whom 42 had PSA followup. Average age at the time of RC in these patients was 72.24 ± 9.52 years, with a median follow up of 2.18 years. Mean baseline PSA prior to surgery was 4.45±7.49. Two (4.7%) patients developed a recurrence of their prostate cancer, aged 66 and 65 at the time of surgery, and diagnosed 6.8 and 6.1 years after RC. Both had Gleason grade 3+4 on RC pathology, with no capsule penetration, bladder extension, seminal vesicle involvement, or nodal extension. PSA at the time of recurrence was 0.12 and 43.6 each. PSA peaks were 0.52 and 80.6, respectively. The first was diagnosed based on an enlarged lymph node on routine postoperative cross sectional imaging followed by a steady rise in PSA, which was ultimately biopsy proven PCA. He was unable to undergo radiotherapy because his neobladder would not tolerate the doses of radiation required for prostate cancer and refused ADT. The second was diagnosed based on a markedly elevated PSA, and underwent ADT with a normalization of his markers. He had a marker relapse 3 years after cessation of ADT. Both were alive at last follow up, 6.9 and 9.5 years post-surgery. CONCLUSIONS Less than 5% of patients develop a relapse after diagnosis of csPCA on RC pathology. The relative paucity of recurrence makes it difficult to establish parameters for monitoring, however time to diagnosis (>6 years) suggests long term-follow up in these patients may be necessary to monitor for recurrence. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1082 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Swar Shah More articles by this author Soroush Bazaragani More articles by this author Gus Miranda More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Sep 7, 2023
Xu Zhang + 2
Open Access