Frequency and prognostic significance of incidental prostate cancer at radical cystectomy: Results from an international retrospective study

To analyze the frequency of incidental prostate cancer (PC) at radical cystoprostatectomy (RC) for urothelial carcinoma of the bladder (UCB) and its association with survival outcomes in an international cohort.

In this retrospective study, we included 2114 who underwent RC and lymphadenectomy for UCB between 1976 and 2012 male patients from seven institutions. Univariable and multivariable Cox regression models addressed the association of incidental PC with cancer-specific mortality and overall mortality after RC.

Overall, incidental PC was found in 513 (24.3%) patients with the lowest frequency in a Japanese center (23/164, 11.2%) and the highest frequency in a North American center (122/325, 37.5%), respectively (p < 0.001). Within a median follow up of 27 months (IQR: 50 months), 20 patients (3.9%) were diagnosed with biochemical recurrence (BCR) and none of the patients died of PC. PC pathological tumor stage was more advanced in patients experiencing BCR (p < 0.001). In multivariable Cox regression analyses adjusted for standard clinicopathologic features, incidental PC was not associated with cancer-specific (HR: 1.11, 95% CI: 0.91-1.35, p = 0.30) or overall mortality (HR: 1.06, 95% CI: 0.83-1.35, p = 0.65).

Incidental PC at RC for UCB is a frequent event. However, the majority of PC cases are well-differentiated and organ-confined. Presence of incidental PC shows significant geographic differences. The risk of BCR after incidental PC is low and incidental PC is not associated with survival in UCB patients treated with RC.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2017 Sep 07 [Epub ahead of print]

Rieken Malte, Luis A Kluth, Dharam Kaushik, Stephen A Boorjian, Mohammad Abufaraj, Beat Foerster, Michael Rink, Kilian Gust, Florian Roghmann, Joachim Noldus, Dimitri Vordos, Masayuki Hagiwara, Eiji Kikuchi, Masaomi Ikeda, Kazumasa Matsumoto, Pierre I Karakiewicz, Morgan Rouprêt, Alberto Briganti, Douglas S Scherr, Shahrokh F Shariat, Veronika Seebacher

Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA., Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan., Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland., Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Ruhr-University Bochum, Marienhospital, Herne, Germany., Department of Urology, Hôpital Henri Mondor Créteil, Créteil, France., Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan., Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan., Department of Urology, University of Montreal, Montreal, QC, Canada., Department of Urology, AP-HP, Hopital Pitié-Salpétrière, Service d'Urologie, Paris, France., Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA., Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Electronic address: ., Department for Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria.