Objective: The aim of the study was to evaluate the impact of the clinical significance of incidental prostate cancer (PC) on overall survival (OS) after radical cystoprostatectomy (RC) for bladder cancer (BC). Methods: A total of 822 consecutive men underwent RC in 3 academic centers between 1996 and 2011. The clinical significance of incidental PC was determined according to the Epstein criteria. The Kaplan-Meier analysis with log-rank was used to investigate the impact of PC on OS and univariate and multivariate Cox regression analyses for risk factors of OS. The median follow-up was 36 months (interquartile range 10-49). Results: Of the 822 men, 117 (14.2%) had clinically significant, 243 (29.6%) insignificant and 462 (56.2) no PC at RC. Men with PC were at higher risk for lymphovascular invasion (LVI) of BC compared to men without PC (p < 0.001). The 5-year OS for men with clinically significant, insignificant and no PC was 33.3, 51.3 and 51.5%, respectively (p = 0.050). In the subgroup of pN0 patients (n = 601), clinically significant PC was significantly associated with inferior OS (p = 0.044) but not in multivariable analysis (p = 0.46). Conclusions: We did not find the clinical significance of incidental PC to be an independent predictor. However, the positive correlation between incidental PC and LVI of BC deserves further investigation.

Keywords:
Overall survival, Outcome, Prostate cancer, Bladder cancer, Clinically significant, Incidental, Radical cystectomy
1.
Gakis G, Efstathiou J, Lerner SP, et al: ICUD-EAU international consultation on bladder cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2013;63:45-57.
2.
Witjes JA, Comperat E, Cowan NC, et al: EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2014;65:778-792.
3.
Stein JP, Lieskovsky G, Cote R, et al: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2011;19:666-675.
4.
Shariat SF, Karakiewicz PI, Palapattu GS, et al: Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clin Cancer Res 2006;12:6663-6676.
5.
Gakis G, Schilling D, Bedke J, et al: Incidental prostate cancer at radical cystoprostatectomy: implications for apex-sparing surgery. BJU Int 2010;105:468-471.
6.
Gakis G, Stenzl A, Renninger M: Do we use the right criteria for determining the clinical significance of incidental prostate cancer at radical cystoprostatectomy? Scand J Urol 2013;47:358-362.
7.
Damiano R, Di Lorenzo G, Cantiello F, et al: Clinicopathologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence-based analysis. Eur Urol 2007;52:648-657.
8.
Bruins HM, Djaladat H, Ahmadi H, Sherrod A, Cai J, Miranda G, et al: Incidental prostate cancer in patients with bladder urothelial carcinoma: comprehensive analysis of 1,476 radical cystoprostatectomy specimens. J Urol 2013;190:1704-1709.
9.
Gakis G, Stenzl A: Gender-specific differences in muscle-invasive bladder cancer: the concept of sex steroid sensitivity. World J Urol 2013;31:1059-1064.
10.
Gakis G, Stenzl A, Renninger M: Evolution of the concept of androgen-sensitive bladder cancer. Scand J Urol 2013;47:173-178.
11.
Sobin DH, Wittekind C: TNM Classification of Malignant Tumours. New York, Wiley-Liss, 2002.
12.
Shim JW, Cho KS, Choi YD, et al: Diagnostic algorithm for papillary urothelial tumors in the urinary bladder. Virchows Arch 2008;452:353-362.
13.
McNeal JE, Redwine EA, Freiha FS, Stamey TA: Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 1988;12:897-906.
14.
Epstein JI, Walsh PC, Carmichael M, Brendler CB: Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994;271:368-374.
15.
Brunocilla E, Pernetti R, Martorana G: The prognostic role of lymphovascular invasion in urothelial-cell carcinoma of upper and lower urinary tract. Anticancer Res 2011;31:3503-3506.
16.
Rink M, Fajkovic H, Cha EK, et al: Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma. Eur Urol 2012;61:854-855.
17.
Sruogis A, Ulys A, Smailyte G, et al: Incidentally found prostate cancer and influence on overall survival after radical cystoprostatectomy. Prostate Cancer 2012;2012:690210.
18.
Buse S, Höfner T, Müller SC, et al: Characterization and risk stratification of prostate cancer in patients undergoing radical cystoprostatectomy. Int J Urol 2013;20:866-871.
19.
Pignot G, Salomon L, Neuzillet Y, et al: Clinicopathological characteristics of incidental prostate cancer discovered from radical cystoprostatectomy specimen: a multicenter French study. Ann Surg Oncol 2014;21:684-690.
20.
Macek P, Sanchez-Salas R, Rozet F, et al: Prostate-sparing radical cystectomy for selected patients with bladder cancer. Urol Int 2013;91:89-96.
21.
Davies JD, Simons CM, Ruhotina N, et al: Anatomic basis for lymph node counts as measure of lymph node dissection extent: a cadaveric study. Urology 2013;81:358-363.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.