Radikal Sistoprostatektomi Materyalinde İnsidental Prostat Kanseri Saptanan Olguların Klinikopatolojik Özellikleri

Öz

Mesane kanseri tedavisinde yaygın olarak uygulanan radikal sistoprostatektomi materyallerinde klinik bulgu vermeyen, insidental prostat kanserlerine sıklıkla rastlanmaktadır. Çalışmamızda, merkezimizde radikal sistoprostatektomi uygulanan hastalarda prostat kanseri insidansını, evresini, histopatolojik özellikleri ve bu tümörlerin prognoza etkisini değerlendirmeyi amaçladık. 2006 - 2020 arasında merkezimizde mesane kanseri nedeniyle radikal sistoprostatektomi uygulanan 499 hastaya ait dosyalar retrospektif olarak incelendi. İnsidental prostat tümörü 141 (%28,3) olguda tespit edildi. Tümörlerin tamamı prostat asiner adenokarsinomu olarak tanı aldı. 127 (%90,1) hasta pT2, 10 (%7,1) hasta pT3a ve 4 (%2,8) hasta pT3b tümöre sahipti. 35 (%24,8) hastada klinik olarak önemli prostat kanseri mevcuttu. Ameliyat öncesi artmış PSA değerine sahip 14 hastadan 4’ü klinik olarak anlamlı prostat tümörüne sahipti. Radikal sistoprostatektomi materyallerinde insidental prostat tümörü saptanma oranları yüksektir ancak tümörlerin çoğu klinik olarak önemsiz grupta yer alır. Serum PSA değerinin ameliyat öncesi insidental tümörü tespitinde faydası sınırlıdır. İnsidental prostat tümörüne sahip hastalarda olumsuz klinik seyir izlenmemekle birlikte prognozun asıl belirleyicisi mesane tümörüdür.

Anahtar Kelimeler

• Adenokarsinom
• İnsidental
• Prostat
• Sistoprostatektomi

Clinicopathological Characteristics of Incidental Prostate Tumors Detected in Radical Cystoprostatectomy Materials

Öz

Incidental prostate cancers are frequently encountered in radical cystoprostatectomy materials, which are widely used in the treatment of bladder cancer. We aimed to evaluate incidental prostate cancer’s incidence, stage, histopathological features and their effect on prognosis in patients who underwent radical cystoprostatectomy in our center. 499 patients who underwent radical cystoprostatectomy for bladder cancer between 2006 and 2020 were retrospectively evaluated. Incidental prostate tumor was detected in 141 (28.3%) cases. All tumors were diagnosed as prostate acinar adenocarcinoma. 127 (90.1%) patients had pT2, 10 (7.1%) patients had pT3a and 4 (2.8%) patients had pT3b tumor. Clinically significant prostate cancer was present in 35 (24.8%) patients. Of the 14 patients with an increased PSA level preoperatively, 4 had a clinically significant prostate tumor. Incidence of incidental prostate tumor is high in radical cystoprostatectomy materials, but most of them are clinically insignificant. The benefit of preoperative evaluation of serum PSA for the detection of incidental tumors is controversial. Although an unfavorable clinical course is not observed in patients with incidental prostate tumor, the main determinant of prognosis is the bladder tumor.

Anahtar Kelimeler

• Adenocarcinoma
• Cystoprostatectomy
• Insidental
• Prostate

Kaynakça

1. 1. Wu S, Lin SX, Lu M, et al. Assessment of 5-year overall survival in bladder cancer patients with incidental prostate cancer identified at radical cystoprostatectomy. Int Urol Nephrol 2019;51(9):1527–35.
2. 2. Tanaka T, Koie T, Ohyama C, et al. Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy. Jpn J Clin Oncol 2017;47(11):1078–82.
3. 3. Jønck S, Helgstrand JT, Røder MA, et al. The prognostic impact of incidental prostate cancer following radical cystoprostatectomy: a nationwide analysis. Scand J Urol 2018;52(5–6):358–63.
4. 4. Yazici CM, Bozkurt S, Türkeri L, et al. Ortotopik Mesane Yapılan Sistektomide Prostat Korunması Güvenilir Bir Yöntem Midir? Türk Onkol Derg 2005;31(4):485–9.
5. 5. Pan J, Xue W, Sha J, et al. Incidental Prostate Cancer at the Time of Cystectomy: The Incidence and Clinicopathological Features in Chinese Patients. Black PC (ed). PLoS One 2014;9(4):e94490.
6. 6. Filter ER, Gabril MY, Gomez JA, et al. Incidental Prostate Adenocarcinoma in Cystoprostatectomy Specimens: Partial Versus Complete Prostate Sampling. Int J Surg Pathol 2017;25(5):414–20.
7. 7. Abdelhady M, Abusamra A, Pautler SE, Chin JL, Izawa JI. Clinically significant prostate cancer found incidentally in radical cystoprostatectomy specimens. BJU Int 2007;99(2):326–9.
8. 8. Montironi R, Mazzucchelli R, Santinelli A, et al. Incidentally detected prostate cancer in cystoprostatectomies: pathological and morphometric comparison with clinically detected cancer in totally embedded specimens. Hum Pathol 2005;36(6):646–54.

9. 9. 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(3):648–57.
10. 10. Packiam VT, Tsivian M, Avulova S, et al. Long-term outcomes of incidental prostate cancer at radical cystectomy. Urol Oncol Semin Orig Investig 2020;38(11):848.e17-848.e22.
11. 11. Aytac B, Vuruskan H. Clinicopathologic features of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens. World J Surg Oncol 2011;9(1):81.
12. 12. College of American Pathologists. Cancer Protocol Templates, Prostate Gland. cap.org/cancerprotocols. Accessed May 11, 2021.
13. 13. Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2016;40(2):244–52.
14. 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(5):368–74.
15. 15. Wetterauer C, Weibel M, Gsponer JR, et al. Incidental prostate cancer prevalence at radical cystoprostatectomy—importance of the histopathological work-up. Virchows Arch 2014;465(6):629–36.
16. 16. Fritsche HM, Aziz A, Eder F, et al. Potentially clinically relevant prostate cancer is found more frequently after complete than after partial histopathological processing of radical cystoprostatectomy specimens. Virchows Arch 2012;461(6):655–61.
17. 17. Jin X-D, Chen Z-D, Wang B, et al. Incidental prostate cancer in radical cystoprostatectomy specimens. Asian J Androl 2008;10(5):809–14.
18. 18. Yang X, Monn MF, Liu L, et al. 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. Prostate 2015;75(8):845–54.
19. 19. Pignot G, Salomon L, Lebacle C, et al. Prostate cancer incidence on cystoprostatectomy specimens is directly linked to age: results from a multicentre study. BJU Int 2015;115(1):87–93.
20. 20. Xu H, Zhu Y, Dai B, Ye D-W. National Comprehensive Cancer Network (NCCN) risk classification in predicting biochemical recurrence after radical prostatectomy: a retrospective cohort study in Chinese prostate cancer patients. Asian J Androl 2018;20(6):551.
21. 21. Gakis G, Rink M, Fritsche H-M, et al. Prognostic Significance of Incidental Prostate Cancer at Radical Cystoprostatectomy for Bladder Cancer. Urol Int 2016;97(1):42–8.
22. 22. Nakagawa T, Kanai Y, Komiyama M, Fujimoto H, Kakizoe T. Characteristics of prostate cancers found in specimens removed by radical cystoprostatectomy for bladder cancer and their relationship with serum prostate-specific antigen level. Cancer Sci 2009;100(10):1880–4.
23. 23. Lopez-Beltran A, Cheng L, Montorsi F, et al. Concomitant bladder cancer and prostate cancer: challenges and controversies. Nat Rev Urol 2017;14(10):620–9.
24. 24. Sanli O, Acar O, Celtik M, et al. Should Prostate Cancer Status Be Determined in Patients Undergoing Radical Cystoprostatectomy? Urol Int 2006;77(4):307–10.
25. 25. Thomas C, Wiesner C, Melchior S, et al. Indications for Preoperative Prostate Biopsy in Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer. J Urol 2008;180(5):1938–41.
26. 26. Hiroš M, Spahović H, Selimović M, Sadović S. Incidental Prostate Cancer in Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer. Bosn J Basic Med Sci 2008;8(2):147–51.
27. 27. Dell’Atti L. Relevance of prostate cancer in patients with synchronous invasive bladder urothelial carcinoma: a monocentric retrospective analysis. Arch Ital di Urol e Androl 2015;87(1):76.
28. 28. Tang S, Hao H, Fang D, et al. Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center. Int braz j urol 2018;44(2):258–66.