Prevalence and Pathological Analysis of Adenocarcinoma Prostate Discovered Incidentally in Radical Cystoprostatectomy Specimen: An Indian Center Experience XC01-XC03
Dr. Rajat Mahadik,
Senior Resident, Department of Urology, Amrita Institute of Medical Sciences, Edappaly, Kochi-682041, Kerala, India.
Introduction: Potency-preserving techniques of radical cystectomy raise concern because of a possible association with incidental prostate adenocarcinoma. Cystoprostatectomy specimen provides a unique opportunity to estimate the prevalence and to define the morphological features of silent (incidental) adenocarcinoma of the prostate.
Aim: To determine the prevalence and histopathological features of incidental prostate carcinoma detected in radical cystoprostatectomy specimens taken for muscle invasive bladder cancer.
Materials and Methods: A retrospective chart review of patients who underwent radical cystoprostatectomy for infiltrating bladder tumors during the period between 2003 and April 2014 was done. The histopathology slides of these patients were reviewed.
Results: Fourteen incidental prostate cancers were identified in 113 radical cystoprostatectomies. The mean patientâ€™s age was 65 years (range 48-75 years). The median Gleason Score was 3+3 (3+3, 4+3). Nine patients (64%) had Gleason 6 and five (36%) had Gleason 7 disease. Pelvic lymph node metastasis from prostate adenocarcinoma was detected in four patients. On mean follow up of 2.5 years for three patients with node positive disease there was no evidence of biochemical recurrence. For patients with node negative disease, six patients had no evidence of recurrence on a follow up of 3.5 years.
Conclusion: Percentage of incidentally detected prostate cancer in cystoprostatectomy specimen at our clinical center is much lower (12.4%) than reported rates in the world until now (23-68%), which can be attributed to varying methods of pathological examination and regional difference in prostate cancer . It would be prudent to do digital rectal examination (for clinical prostate evaluation) and Prostate-Specific Antigen (PSA) testing along with bladder cancer work up.