Background:
The rate of incidental prostate cancer found at cystoprostatectomy for bladder cancer has been well documented. We reviewed the incidence and outcome of incidental prostate cancer considered clinically significant, which would impact on follow-up post-cystoprostatectomy.
Methods:
The pathology records of 217 men who had undergone radical cystoprostatectomy from 1987-2003, identifying those with incidental prostate adenocarcinoma and no prior history or clinical findings consistent with prostate cancer pre-operatively. The prostate gland had been routinely sectioned and histologically examined in all patients. Office and hospital charts were reviewed to capture data to determine if clinically significant prostate cancer was identified in this patient cohort following cystoprostatectomy.
Results:
Fifty-seven out of 204 (28%) patients overall were found to have prostate cancer (median age 67). Median follow-up was 43 months (range 6-149). 26 patients (46%) died from metastatic bladder cancer or other causes. The respective bladder cancer staging was pT0, pTis, pT1, pT2, pT3, and pT4 in 6, 1, 3, 19, 18, and 10 patients, respectively. The prostate cancer staging was pT2a, pT2b, pT2c, pT3, and unknown in 29, 7, 16, 3, and 2 patients, respectively. The respective Gleason score was 3-4, 5, 6, 7, and 8-10 in 8, 9, 26, 11, and 1 patient with 2 patients listed simply as well-differentiated. 21% of patients with prostate cancer had a Gleason score >7. One of the patients had prostate cancer and transitional cell carcinoma in the same lymph node (collision tumour). There were two documented prostate cancer recurrences. One patient had recurrence of prostate cancer on histopathological examination after lobectomy for pulmonary nodules. The second patient had a positive apical resection margin at cystoprostatectomy. Ten years later, the patient was found to have an anterior rectal wall mass and PSA value of 110 ng/ml.
Conclusions:
Incidental prostate cancer is a relatively common finding in radical cystoprostatectomy specimens for bladder cancer. Grade and stage of such cancers are widely distributed and >30% may be considered clinically significant and that supports the removal of the prostate gland in many men with bladder cancer. Vigilant follow-up of both bladder cancer and prostate cancer is mandatory. The frequency and intensity of follow-up for the prostate cancer component should be tailored according to the histologic grade and stage of prostate cancer.

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