Preoperative findings, pathological stage PSA recurrence in men with prostate cancer incidentally detected at radical cystectomy: Our experience in 242 cases

Pietro Pepe, Filippo Fraggetta, Antonio Galia, Paolo Panella, Michele Pennisi, Maurizio Colecchia, Francesco Aragona

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Preoperative findings, pathological stage PSA recurrence in patients with prostate cancer incidentally detected (iPCa) at radical cystectomy (RCP) were prospectively evaluated. Methods: From July 2000 to July 2013, 242 men 71 years old (median) underwent RCP; preoperatively, all patients underwent digital rectal examination (DRE), total and free/total PSA. The bladder was totally examined; moreover, the prostate gland was step-sectioned at 4-mm intervals. The incidence of iPCa that fulfilled criteria for clinically significant iPCa was recorded: tumor volume ≥0.5 mL, Gleason grade ≥4, extracapsular extension, seminal vesicle invasion, lymph node metastasis or positive surgical margins. In the presence of iPCa, the patients underwent PSA evaluation during the follow-up and recurrence was defined as two subsequent rises >0.2 ng/mL. Results: Among the 50 (20.6 %) out of 242 patients submitted to RCP, an iPCa was found and 18 (36 %) of them met criteria for insignificant iPCa; moreover, 30 % of the patients had apex involvement. Median total PSA and PSA F/T values were not significantly different in the presence versus the absence of iPCa (2.6 vs 2.7 ng/mL and 26 vs 27 %; p > 0.05) and between significant versus insignificant iPCa (p > 0.05). None of the patients during the follow-up (median 58 months; range 6-102 months) had PSA recurrence. Conclusions: PSA and PSA F/T values are provided for poor accuracy in distinguishing preoperatively significant from insignificant iPCa; however, the life expectancy of the patients is dramatically influenced by bladder cancer pTN (in our series, none developed PSA failure). In younger men in whom a prostate-sparing cystectomy could be proposed, an accurate preoperative evaluation should be mandatory to rule out significant iPCa at the risk of apex involvement (in our series equal to 30 % of the cases).

Original languageEnglish
Pages (from-to)1325-1328
Number of pages4
JournalInternational Urology and Nephrology
Volume46
Issue number7
DOIs
Publication statusPublished - 2014

Keywords

  • Incidental prostate cancer
  • Insignificant prostate cancer
  • Prostate cancer
  • Radical cystectomy

ASJC Scopus subject areas

  • Nephrology
  • Urology
  • Medicine(all)

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