| [Aim]:To investigate the incidence and histopathological features of incidental prostate cancer.(PCa)and urothelial carcinoma(UCa)in prostate found in radical cystoprostatectomy(RCP)specimens,who underwent RCP for bladder cancer(BCa).[Patients and methods]:From January 2015 to December 2017,the urology department of second affiliated hospital,Kunming medical university performed 210 radical cystoprostatectomy(RCP)for muscle invasive,recurrent and multiple transitional cell carcinoma(TCC)of bladder.Preoperative prostate specific antigen(PSA),digital rectal examination(DRE),chest X-ray,intravenous pyelogram,and either computed tomography(CT)scan or magnetic resonance imaging(MRI)scan were analyzed.The whole RCP specimen were mounted serially and was cut transversely at 3mm intervals and examined in same pathological center.Clinically significant PCa was defined as a tumor with a Gleason pattern ? 4,prostate tumor with clinical stage>pT3,lymph node involvement,positive surgical margin or multifocality of three or more lesions.[Results]:Out of 210 patients,52(24.5%)had a postoperative diagnosis of incident prostate cancer with an average age of 65.88 years.Out of 52 patients 38 patients had a preoperative PSA median of 1.91 ng/mL;8(15.4%)had a postoperative Gleason score of 7,1(1.9%)score 8,40(76.9%)had score 6,and 3(5.7%)had score 4 or 5;1 case with perineural invasion and 11 had prostate stroma invasion by urothelial carcinoma(UCa)invading base of prostate;26(50%)patients with high grade prostatic intraepithelial neoplasia(HGPIN)and Multifocality in 2(3.8%).The final histopathology diagnosis was of 12 patients with clinically significant PCa(12/52,23.1%),while the other 40 cases(40/52,76.9%)were clinical insignificant prostatic cancer.The mean age of significant and insignificant PCa was 72(range from 62 to 84)and 64.05(range from 43 to 83)years,respectively(p=0.011),there is statistically significant between two groups.PSA was available of 8 cases in clinically significant PCa with a median PSA of 2.02 ng/ml whereas in clinically insignificant PSA was available for 30 patients with a median PSA of 1.88 ng/ml(p=0.265),which is statistically insignificant between two groups.Positive surgical margin was detected in 5 and 1 with perineural invasion in clinically significant group.9 cases with Gleason score of 7 or 8,and 3 with Gleason score of 6 in clinically significant PCa group,whereas insignificant group have Gleason score of 5 or 6.Multifocal tumor was seen in 2 cases in significant group.Prostate Tumors were organ-confined(pT2)in 49 cases(94.3%)and locally advanced(pT3)in 3 cases(5.8%),(p=0.001),which is statistical significant between significant and insignificant PCa.Out of 210 patients 30 patient had urothelial carcinoma either in prostate or prostatic capsule,of which 11 are in incidental prostate cancer and 19 with only UCa,mean age was 65.74(44-86)years.Urothelial carcinoma involving prostate capsule was 16(53.0%)whereas involving prostatic urethra was 14(46.7%),their mean age was 67.0 and 63.43 years respectively,(P= 0.206),which is statistically insignificant for UCa in prostate capsule and prostate urethra.High grade urothelial carcinoma was seen in 26(86.6%)and low grade in 4(13.3%).6(20%)have tumor stage of TI;6(20%)T2a;10(33.3%)T2b;4(13.3%)T3a;1(3.33%)with T3b and 3(10%)with T4,(Pb= 0.035),there is significant relationship between TNM staging and UCa involvement.[Conclusion]:This study found that 24.8%(52/210)of radical cystectomy specimens had incidental prostate cancer.Of the incidental prostate cancer,23.1%were clinically significant prostate cancer and 76.9%were non clinically significant prostate cancer.Incidental prostate cancer is difficult to detect by preoperative PSA examination.After radical cystectomy,attention should be paid to the follow-up of PSA.The incidence of bladder cancer involving prostate capsule or prostatic urethra was 14.3%(30/210). |
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