Incidental Prostate Cancer at the Time of Cystectomy: The Incidence and Clinicopathological Features in Chinese Patients

Abstract

ObjectivesTo evaluate the incidence and the clinicopathological features of incidental prostate cancer detected in radical cystoprostatectomy (RCP) specimens in Chinese men and to estimate the oncological risk of prostate apex-sparing surgery for such patients.MethodsThe clinical data and pathological feature of 504 patients who underwent RCP for bladder cancer from January 1999 to March 2013 were retrospectively reviewed. Whole mount serial section of the RCP specimens were cut transversely at 3–4 mm intervals and examined in same pathological institution.ResultsThirty-four out of 504 patients (6.8%) had incidental prostate cancer with a mean age of 70.3 years. 12 cases (35.2%) were diagnosed as significant disease. 4 cases were found to have apex involvement of adenocarcinoma of the prostate while in 5 cases the prostate stroma invasion by urothelial carcinoma were identified (one involved prostate apex). The mean follow-up time was 46.4±33.8 months. Biochemical recurrence occurred in 3 patients but no prostate cancer-related death during the follow-up. There was no statistical significance in cancer specific survival between the clinically significant and insignificant cancer group.ConclusionsThe prevalence of incidental prostate cancer in RCP specimens in Chinese patients was remarkably lower than in western people. Most of the incidental prostate cancer was clinically insignificant and patient's prognosis was mainly related to the bladder cancer. Sparing the prostate apex was potentially associated with a 1.0% risk of leaving significant cancer of the prostate or urothelial carcinoma.

Incidental prostate cancer in Asian men: High prevalence of incidental prostatic adenocarcinoma in Chinese patients undergoing radical cystoprostatectomy for treatment of bladder cancer and selection of candidates for prostate‐sparing cystectomy

“…The incidence of prostate cancer varies considerably between populations of the world. Most Asian countries, except Korea, present lower rates of incidental prostate cancer when compared with American, European, and Australian countries (Table ) . The present study shows a higher rate (28%) of incidental prostate cancer in China than in the majority of studies from other Asian countries .…”

Is survival after radical cystectomy for bladder cancer in Saudi patients different from that of Western patients?

“…In our series, incidental findings of prostatic adenocarcinoma occurred in 8.5% (23 out of the 268 males) of the cystoprostatectomy specimens. This is similar to China (6.8%) 40 but still lower than in Western countries (25–46%). 41 , 42 Furthermore, whether the presence of prostatic adenocarcinoma is clinically significant is still controversial.…”

Comparisons between magnetic resonance/ultrasound fusion-guided biopsy and standard biopsy in the diagnosis of prostate cancer

“…These results were in line with available studies. [ 5 , 6 , 25 ] However, after proper diagnosis, the cost of overdiagnosis and overtreatment, [ 2 ] which is a major drawback for any condition of prostate cancer in situ could be overcome. In respect to the value factor of biopsies, the further trial is required to justify the expenditure of MRI/US fusion-guided biopsy, considering total charges from mpMRI to radical prostatectomy including hospital stay and medicines for MRI/US fusion-guided biopsy and US-guided biopsy for the Chinese men.…”

“…Prostate-specific antigen (PSA) “gray zone" in Chinese men (10.1–20 ng/mL) is higher than men of western countries (2.5–10 ng/mL) [ 1 ] and the incidence rate of prostate cancer in men of the People's Republic of China is 0.000121%. [ 2 ] The major problems for men with prostate cancer are overdiagnosis and overtreatment. [ 3 ] PSA is widely used for detection of prostate cancer, [ 4 ] but it is not useful for detection of prostate cancer in Chinese men.…”