Contemporary Implications of Incidental Prostate Cancer in Radical Cystoprostatectomy

Abstract

Objective: The aim of this study was to document the incidence, histopathologic characteristics, and clinical features of incidental prostate cancer (IPC) in a series of radical cystoprostatectomies (RCP). Method: The clinical and histopathological features of 96 male patients who underwent RCP between 2018 and 2024 were retrospectively evaluated. Results: IPC was detected in 30 (31.25%) of the patients. The majority of patients with IPC had a Gleason Score of 6 (76.67%) and organ-confined pT1-pT2 disease (90%). On the other hand, 6 (6/30, 20%) of the patients with ICP had clinically significant prostate cancer (PC) (Gleason > 3+4). Preoperative PSA values were higher in IPC patients (3.27 [1.16-5.8] ng/dL vs. 1.24 [0.79-2.36] ng/dL) (p=0.01). Survival was lower in patients with pT3-pT4 disease [13 (26.5%) vs. 25 (53.2%)], positive lymph nodes [7 (14.3%) vs. 16 (34%)], and lymphovascular invasion [12 (24.5%) vs. 29 (61.7%)] (p=0.015, 0.023, and 0.001, respectively) in the pathology of bladder cancer (BC). No difference in overall survival rates was found between patients with and without IPC [16 (32.7%) vs. 14 (29.8%)] (p=0.762). Conclusions: A higher preoperative PSA level could predict the presence of IPC in RCP patients. Approximately 20% of the PC patients had clinically significant PC, which requires PSA monitoring. However, overall survival is primarily related to BC.

Keywords

• Bladder Cancer
• Prostate Cancer
• Radical Cystectomy
• Cystoprostatectomy

Radikal Sistoprostatektomide Saptanan İnsidental Prostat Kanserinin Güncel Klinik Yansımaları

Abstract

Amaç: Bu çalışmanın amacı, radikal sistoprostatektomi (RSP) uygulanan hastalarda insidental prostat kanseri (İPK) insidansını, histopatolojik özelliklerini ve klinik bulgularını değerlendirmektir. Yöntem: 2018–2024 yılları arasında RSP uygulanan 96 erkek hastanın klinik ve histopatolojik özellikleri retrospektif olarak değerlendirildi. Bulgular: Hastaların 30’unda (%31,25) İPK saptandı. İPK saptanan hastaların büyük çoğunluğunda Gleason skoru 6 (%76,67) ve organa sınırlı (pT1–pT2) tümör (%90) mevcuttu. İPK saptanan 6 hastada (6/30, %20) klinik olarak anlamlı prostat kanseri (Gleason > 3+4) saptandı. Preoperatif PSA düzeyleri İPK saptanan hastalarda daha yüksekti (3,27 [1,16–5,8] ng/dL’ye karşılık 1,24 [0,79–2,36] ng/dL) (p=0,01). Mesane kanseri (MK) patolojisinde evre pT3–pT4 hastalık olan, lenf nodu metastazı bulunan ve lenfovasküler invazyon gösteren hastalarda sağkalım oranları daha düşüktü [sırasıyla 13 (%26,5) vs. 25 (%53,2); 7 (%14,3) vs. 16 (%34); 12 (%24,5) vs. 29 (%61,7)] (p=0,015, 0,023 ve 0,001). İPK varlığı ile genel sağkalım oranları arasında anlamlı bir fark saptanmadı [İPK olanlarda 16 (%32,7) vs. olmayanlarda 14 (%29,8)] (p=0,762). Sonuç: Yüksek preoperatif PSA düzeyleri, RSP uygulanan hastalarda İPK varlığının öngörücüsü olabilir. Prostat kanseri saptanan olguların yaklaşık %20’sinde klinik olarak anlamlı prostat kanseri mevcut olup, bu hastalarda PSA takibi önerilmektedir. Bununla birlikte, genel sağkalım esas olarak mesane kanseri ile ilişkilidir.

Keywords

• Mesane kanseri
• Prostat kanseri
• Radikal sistektomi
• Sistoprostatektomi

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