Clinicopathologic Features of Prostate Adenocarcinoma Incidentally Discovered at the Time of Radical Cystectomy: An Evidence-Based Analysis

Rocco Damiano, Giuseppe Di Lorenzo, Francesco Cantiello, Marco De Sio, Sisto Perdonà, Massimo D'Armiento, Riccardo Autorino

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To review all relevant features of incidentally discovered prostate cancer (PCa) in patients undergoing radical cystectomy for bladder cancer: incidence, pathologic characteristics, clinical significance, and implications for its management. Methods: A structured literature review through a MEDLINE search was performed. Results: The frequency of incidentally discovered PCa in cystoprostatectomy specimens is extremely variable because of several factors, particularly the pathology sampling. The relationship among clinically, incidentally, and autopsy-detected cancer is uncertain. The definition of clinically significant cancer varies among published reports and remains inadequate for clinical application. High-grade prostatic intraepithelial neoplasia is a marker for concurrent PCa and the risk depends more on the volume than on its absolute presence. Outcome of patients with unsuspected PCa after cystoprostatectomy relies mostly on the bladder tumor. Conclusions: Incidental PCa in patients with bladder cancer is highly variable and with an unclear clinical significance. For those who are candidates for prostate-sparing surgery, it seems reasonable to include a routine prostate biopsy in the standard preoperative work-up irrespective of prostate-specific antigen values. In the absence of sufficient data to make firm recommendations, when PCa is incidentally discovered, PCa surveillance should be part of the follow-up scheme after radical cystectomy.

Original languageEnglish
Pages (from-to)648-657
Number of pages10
JournalEuropean Urology
Volume52
Issue number3
DOIs
Publication statusPublished - Sep 2007

Keywords

  • Bladder cancer
  • Cystoprostatectomy
  • Incidental
  • Prostate cancer
  • Prostatic intraepithelial neoplasia

ASJC Scopus subject areas

  • Urology

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