Incidental Prostate Cancer Diagnosed At Radical Cystoprostatectomy For Bladder Cancer: Disease-specific Characteristics And Outcomes

Objective: To analyze the prognostic characteristics of incidental prostate cancer(PC)after radical cystoprostatectomy(RC)for bladder cancer(BC),as well as to indicate factors that may influence the peri-operative and post-operative course.Method: The clinical and pathological data of 127 patients who underwent radical cystoprostatectomy for muscular-invasive bladder cancer at Dalian Central Hospital from September 1,2009 to December 31,2016 were reviewed retrospectively.The patients were divided into two groups: patients with coexisting both types of neoplasms and other patients with isolated bladder neoplasm.The clinical data,radiographic data,pathological data and follow-up data were analyzed by statistical methods,Charlson comorbidity index,clavien-dindo scale,to investigate the disease-specific characteristics and outcomes of incidental prostate cancer(PC)after radical cystoprostatectomy(RC)for bladder cancer(BC).Result: The postoperative pathological examination of the 19 patients(15.0%)was consistent with incidental prostate cancer in all of the 127 patients.The mean age of the patients was 69.9 years,with a median age of 70.5 years.The incidence of cancer diagnosed in different stages was as follows T1N0M0 in 4 cases,T2N0M0 in13 cases,T3N0M0 in 2 cases.Within the research group of 127 patients 17 patients(89.5%)were diagnosed with prostate cancer at stages T1–T2.In 14 patients(73.7%)the Gleason Score was estimated at the level of 5–6 points.In 5 out of 19 patients(26.3%)with diagnosed prostate cancer,the Gleason Score was greater than or equal to 7.All patients were followed up for 9 to 72 months,with an average follow-up timeof 43 months.As far as 1 patients are concerned,the attempt to establish the contact failed,while 1 patients were found dead.Biochemical recurrence occurred in no patient.In 10 out of 19 patients(52.6%)cancer infiltrated one lobe of the prostate,with no infiltration of the capsule and seminal vesicles.In another 7 patients(36.8%)cancer infiltrated both lobes of the prostate,without infiltration of the capsule and seminal vesicles.In 1 out of 19 patients(5.3%)cancer infiltrated both lobes of the prostate with the capsula and seminal vesicles.In 1 patient(5.3%)cancer infiltrated both lobes of the prostate with the capsule but without infiltration of the seminal vesicles.The serum PSA(Prostate Specific Antigen)level was determined prior to surgery in 15 patients(78.9%)and the examination revealed an abnormal PSA level in4 patients.In 1 patients the PSA level was measured postoperatively.In 3 out of 19patients(15.8%)the serum PSA level was tested neither before nor after the surgery.The average number of WBC in incidental prostate cancer patients WAS 6.38*10^9/L,as the median was 5.42*10^9/L;The average number of RBC was 4.31*10^9/L,as the median was 4.36*10^9/L;The average number of Hb was 131G/L,as the median was127G/L;The average number of PLT was 210.74*10^9/L,as the median was210*10^9/L;The average number of APTT was 32.09 seconds,as the median was 31.5seconds;The average number of creatinine was 93.21umol/L,as the median was101umol/L.The average number of length of operation was 165 minutes,as the median was 150 minutes;The average number of Intraoperational blood loss was 702 ml,as the median was 500ml;The average number of time of hospitalization after operation was15.75 daysl,as the median was 14 days.In the group of 19 patients with coexisting both types of neoplasms,1 death in postoperative period(up to 90 th day after surgery)occurred.However,it is important that the T stage of bladder cancer was estimated as T4.parameters such as average blood tests parameters,BMI,time of hospitalization after operation,length of operation and intraoperational blood loss,Charlson Comorbidity Index,Post-operative complications do not show any significant differences.Conclusion: The postoperative pathological examination of the 19 patients(15.0%)was consistent with incidental prostate cancer in all of the 127 patients.Thedata on complete blood count,serum of creatinine,collected from 19 patients with 2primary cancers was compared with the corresponding data collected from 107 patients with solitary bladder cancer,statistically does not show any significant differences.The incidental prostate cancer in patients undergoing cystoprostatectomy for muscle-invasive bladder cancer influences neither the surgery itself nor the post-operative period.