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Assessment of 5-year overall survival in bladder cancer patients with incidental prostate cancer identified at radical cystoprostatectomy

International Urology and Nephrology volume 51, pages 1527–1535 (2019)Cite this article

Abstract

Objective

To investigate the oncological impact of incidental prostate cancer (iPCa) found during radical cystoprostatectomy (RCP) on overall survival (OS) prognosis of urothelial carcinoma of the bladder (BCa).

Patients and methods

A total of 122 RCP cases resected between 2002 and 2012 at our center were included for study. Survival of BCa patient was compared using the Kaplan–Meier method and the log-rank test. Cox proportional hazards regression models were used to analyze the impact of iPCa on the 5-year overall mortality of BCa patients after RCP.

Results

Among the 122 BCa cases that underwent RCP, 38 cases (31.1%) had iPCa, in which, 17 cases (44.7%) were identified as clinically significant iPCa (csPCa). BCa patients with iPCa were older (71 vs 64 years, p = 0.004) and had higher preoperative PSA level (3.1 ng/mL vs 1.4 ng/mL, p = 0.017) when compared to those without iPCa. Cases with iPCa showed a more favorable 5-year OS than cases without iPCa, although this difference did not reach statistical significance (p = 0.219). When excluding the higher risk cases with Gleason score (GS) ≥ 4 + 3 and/or preoperative PSA > 10 ng/mL, BCa patients with iPCa showed a significantly longer OS than cases without iPCa on univariate analysis (p = 0.044), but not on multivariate analysis (p = 0.125).

Conclusion

Our results demonstrated that the frequent findings of low-risk iPCa in BCa patients could indicate the potential possibility of shared pathogenesis pathways between iPCa and BCa. Future study with a larger cohort is warranted to validate this result.

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Fig. 1

Abbreviations

BCa:

Urothelial carcinoma of the bladder

MIBC:

Muscle-invasive bladder cancer

NMIBC:

Non-MIBC

RCP:

Cystoprostatectomy

iPCa:

Incidental prostate cancer

csPCa:

Clinical significant iPCa

cisPCa:

Clinical insignificant iPCa

PSA:

Prostate-specific antigen

DRE:

Digital rectal examination

GS:

Gleason score

LVI:

Lymphovascular invasion

PNI:

Perineural invasion

STSM:

Soft-tissue surgical margin

AR:

Androgen receptor

ADT:

Androgen deprivation therapy

IQR:

Interquartile range

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Author notes

  1. Shulin Wu and Sharron X. Lin contributed equally to this work

Affiliations

  1. Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA

    Shulin Wu, Sharron X. Lin, Alexander O. Subtelny, Zongwei Wang, Douglas M. Dahl & Chin-Lee Wu

  2. Department of Pathology, Peking University Health Science Center, Beijing, China

    Min Lu

  3. Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Aria F. Olumi

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  1. Shulin Wu
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  2. Sharron X. Lin
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  3. Min Lu
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Wu, S., Lin, S.X., 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 51, 1527–1535 (2019). https://doi.org/10.1007/s11255-019-02181-7

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  • DOI: https://doi.org/10.1007/s11255-019-02181-7

Keywords

  • Bladder cancer
  • Incidental prostate cancer
  • Cystoprostatectomy
  • Prognosis
  • Androgen receptor