Ürotelyal mesane kanseri tanısı ile radikal sistoprostatektomi yapılan hastalardaki rastlantısal prostat kanseri sıklığı ve klinik önemi

Abstract

Amaç: Mesane tümörü nedeniyle radi- kal sistoprostatektomi yapılan ve rastlantısal prostat adenokarsinomu saptanan hastaların insidansı, histopatolojik değerlendirme so- nuçları ve onkolojik sonuçlara etkisinin ince- lenmesi amaçlanmıştır.

Materyal ve Metod: Kliniğimizde Ocak 2010 ve Aralık 2017 tarihleri arasında mesane tümörü tanısıyla radikal sistoprostatektomi yapılan ve preoperatif prostat kanseri şüphesi ve tanısı olmayan 190 hasta çalışmaya dahil edildi. Hastalar rastlantısal prostat kanseri saptanan ve saptanmayan grup olarak ikiye ayrıldı. Her iki grup yaş, operasyon öncesi PSA değeri, vücut kitle indeksi, mesane tü- mör evresi, derecesi, eşlik eden karsinoma in situ varlığı, cerrahi sınır pozitifliği, lenf nodu tutulumu ve genel sağkalım açısından karşılaştırıldı.

Bulgular: Hastaların klinik ve histopatolojik verileri Tablo-1 ve Tablo-2’de özetlen- miştir. Histopatolojik incelemede hastaların 43`ünde (%22,6) prostat adenokarsinomu saptandı. Prostat kanseri saptanan hastalardaki operasyon öncesi ortalama PSA değeri 5,38 ng/ml ve prostat kanseri saptanmayan grupta ortalama PSA değeri 2,72 ng/ml idi (p=0,015). Ortalama takip süresi 26 ay (3-74) idi. Prostat kanseri nüksü 5 (%11,6) hastada saptandı. Beş yıllık genel sağkalım prostat kanseri saptanan hastalar için %61, prostat kanseri saptanmayan hastalar için %53 olarak sapandı (p=0,471).

Sonuç: Radikal sistoprostatektomi sonrası rastlantısal prostat kanseri görülme sıklığı yaş ile birlikte artmakta ancak hastaların prognozunu kötü yönde etkilememektedir. Özellikle lokal ileri prostat kanserli hastalarının dikkatli ve düzenli takip edilmeleri gerekmektedir. 

Keywords

• Prostat Kanser,Mesane Kanseri,Radikal Sistektomi

The frequency of the incidental prostate cancer of the patients that were diagnosed as bladder cancer and underwent radical cystectomy and the oncological outcomes

Abstract

Objective: The aim of this study was to evaluate the incidence, histopathological results and oncologic outcome of patients who underwent radical cystoprostatectomy for bladder tumors and detected incidental pros- tate adenocarcinoma.

Materials-Methods: 190 patients who were not proved to have preoperative prostate cancer and underwent radical cystoprostatectomy and diagnosed as prostate cancer as a second cancer between January 2010 and December 2017 were included in this study. Patients were randomly divided into two groups those with and without incidentally prostate cancer. Both groups were compared in terms of age, preoperative PSA value, body mass index, stage and grade of bladder tumor, accompanying of carcinoma in situ, surgical margin positivity, lymph node involvement and overall survival retrospectively.

Results: The clinical and the histopathological features of the patients were summarized on Table 1 and Table 2. Fourtthree of the 190 patients (22.6 %) were detected prostate adenocarcinoma by the histopathological evaluation. The mean preoperative PSA level was 5.38 ng / ml in patients who had prostate cancer and the mean PSA value in the group without prostate cancer was 2.72 ng/ ml (p=0,015). The mean duration of follow-up was 26 (3-74) months. The biochemical recurrence was detected at 5 (11.6%) patients during the follow-up. When the two groups were evaluated for 5-year survival rates that was 61% for patients with prostate cancer and 53% for patients without prostate cancer (p=0.471).

Conclusion: The incidence of incidental prostate cancer after radical cystoprostatectomy increases with age but does not affect the prognosis of patients. In particular, the patients with locally advanced prostate cancer were needed to follow carefully and regularly. 

Keywords

• rostate Cancer,Bladder Cancer,Radical Cystectomy

References

1. 1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin 2018; 68: 7-30.
2. 2. Greiman AK, Rosoff JS, Prasad SM. Association of Human Development Index with global bladder, kidney, prostate and testis cancer incidence and mortality. BJU Int 2017; 120: 799-807.
3. 3. Aydın S, Boz MY. Rapid changes in the incidence of urinary system cancers in Turkey. Turk J Urol 2015; 41: 215-20.
4. 4. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major pat- terns in GLOBOCAN 2012. Int J Cancer 2015; 136: 359-86.
5. 5. Siegel RL, Miller KD,Jemal A. Cancer statistics, 2016. CA cancer J Clin 2016; 66: 7-30.
6. 6. Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non–muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 2011; 59: 997-1008.
7. 7. Lee SH, Chang PL, Chen SM et al. Synchronous primary carcinomas of the bladder and prostate. Asian JAndrol 2006; 8: 357-9.
8. 8. Gakis G, Rink M, Fritsche HM, et al. Prognostic significance of incidental prostate cancer at radical cystoprostatectomy for bladder cancer. Urol Int 2016; 97: 42-8.

9. 9. Damiano R, Di Lorenzo G, Cantiello F, et al. Clinicopat- hologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence- based analysis. Eur Urol 2007; 52: 648-57.
10. 10. 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: 358-62.
11. 11. Pignot G, Salomon L, Lebacle C, et al. Prostate cancer inciden- ce on cystoprostatectomy specimens is directly linked to age: results from a multicentre study. BJU Int 2015; 115: 87-93.
12. 12. Fahmy O, Khairul-Asri MG, Schubert T, et al. Clinicopatho- logical features and prognostic value of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens: A systematic review and meta-analysis of 13,140 patients. J Urol 2017; 197: 385-90.
13. 13. Heidegger I, Oberaigner W, Horninger W, Pichler R, et al. High incidence of clinically significant concomitant pros- tate cancer in patients undergoing radical cystectomy for bladder cancer: A 10-year single-center experience. Urol Oncol 2017;35: 152.e1-152.e5.
14. 14. Mayer EK, Beckley I, Winkler M.H. Lymphoepithelioma-li- ke carcinoma of the urinary bladder. Diagnostic and clinical implications. Nat Clin Pract Urol 2007; 4: 167-171.
15. 15. Pettus JA, Al-Ahmadie H, Barocas DA, et al. Risk assess- ment of prostatic pathology in patients undergoing radical cystoprostatectomy. Eur Urol 2008; 53: 370-375.
16. 16. Dy GW, Gore JL, Forouzanfar MH, Naghavi M, Fitzmaurice C, et al. Global burden of urologic cancers, 1990–2013. Eur Urol 2017; 71: 437-446.
17. 17. Bell KJ, Del Mar C, Wright G, Dickinson J, Glasziou P, et al. Prevalence of incidental prostate cancer: A systematic revi- ew of autopsy studies. Int J Cancer, 2015; 137: 1749-1757.
18. 18. Pignot G, Salomon L, Neuzillet Y, et al. Oncologic Commit- tee of the French Association of Urology. Clinicopathologi- cal characteristics of incidental prostate cancer discovered from radical cystoprostatectomy specimen: A multicenter French study. Ann Surg Oncol 2014; 21: 684-690.
19. 19. Fakhrejahani F, Madan RA, Dahut WL. Management Op- tions for Biochemically Recurrent Prostate Cancer. Curr Treatment Options Oncol 2017; 18: 26.
20. 20. Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New Eng J Med 2016; 375: 1415-24.
21. 21. Kristiansen A, Drevin L, Delahunt B. Prognostic significan- ce and biopsy characteristics of prostate cancer with semi- nal vesicle invasion on radical prostatectomy: a nationwide population-based study. Pathology 2017; 49: 715-20.
22. 22. Canter D, Long C, Kutikov A, et al. Clinicopathological out- comes after radical cystectomy for clinical T2 urothelial car- cinoma: further evidence to support the use of neoadjuvant chemotherapy. BJU Int 2011; 107: 58-62.
23. 23. Nolen SC, Evans MA, Fischer A, et al. Cancer− Incidence, Prevalence and Mortality in the Oldest-Old. A Comprehensive Review. Mech Ageing Dev 2017; 164: 113-126.
24. 24. Wang HJ, Pui MH, Guo Y, et al. Diffusion-weighted MRI in bladder carcinoma: the differentiation between tumor re- currence and benign changes after resection. Abdom Imaging 2014; 39: 135-41.
25. 25. Selimoğlu A, Türk A, Hamarat MB, et al. Ürotelyal Mesane Kanseri Nedeniyle Radikal SistoprostatektomiYapılan Hastalarda Rastlantısal Prostat Kanseri Sıklığı. J Kartal TR 2014; 25: 53-7.
26. 26. Türk H, Karabıçak M, Ün S, et al. Radikal sistoprostatek- tomi yapılan hastalarda prostat kanseri insidansı ve klinik önemi. Ege J Med 2015; 54: 65-9.
27. 27. Ceylan Y, Şen V, Polat S, et al. İnvaziv Üretelyal Mesane Kanseri Nedeniyle Sistoprostatektomi Yapılan Hastalarda Rastlantısal Prostat Kanseri Sıklığı ve Histopatolojik İnce- lemesi. Bull Oncol 2016; 15: 61-4.
28. 28. Ugurlu Ö, Öztekin V, Kosan M, et al. “The Impact of Co- Existing Prostate Adenocarcinoma with Bladder Carcinoma on Disease Specific Survival of The Patients in Our Radical Cystoprostatectomy Series. J Clin Anal Med 2010; 2: 1-4.
29. 29. Sarı A, Ermete M, Çallı A, Girgin C. ÜrotelyalKarsinomlu 191 Olgunun Radikal Sistektomi Materyalinde Histopatolo- jik İnceleme. J Turgut Özal Tıp 2007; 14:75-80.
30. 30. Hızlı F, Arık İ, Başay S, Benzer E, Uygur CM et al. Mesa- ne Kanseri Nedeniyle Radikal Sistoprostatektomi Yapılan Hastalarda Rastlantısal Prostat Kanser Oranı. Uroonkoloji 2005; 31: 490-94.
31. 31. Başpınar Ş,Bircan S, Devrim T, et al. Radikal Sistoprostatek- tomi Materyallerinde Saptanan Rastlantısal Prostat Kanser- leri. Turkiye Klinikleri J Med Sci 2013; 33: 33-8.
32. 32. Valerio M, Donaldson I, Emberton M, et al. Detection of clinically significant prostate cancer using magnetic reso- nance imaging–ultrasound fusion targeted biopsy: a syste- matic review. Eur Urol 2015; 68: 8-19.
33. 33. Wu JN, Fish KM, Evans CP, et al. No improvement noted in overall or cause‐specific survival for men presenting with metastatic prostate cancer over a 20‐year period. Cancer 2014; 120: 818-23.