Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy
Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy
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DOI：
10.1093/jjco/hyx119
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发表时间：
2017-11
影响因子：
2.4
通讯作者：
Toshikazu Tanaka;T. Koie;C. Ohyama;Y. Hashimoto;A. Imai;Y. Tobisawa;S. Hatakeyama;H. Yamamoto;T. Yoneyama;H. Horiguchi*;H. Kodama;T. Yoneyama
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文献类型：
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作者：
Toshikazu Tanaka;T. Koie;C. Ohyama;Y. Hashimoto;A. Imai;Y. Tobisawa;S. Hatakeyama;H. Yamamoto;T. Yoneyama;H. Horiguchi*;H. Kodama;T. Yoneyama
目的分析根治性膀胱切除术（radical cystostomectomy，RCP）中意外发现的前列腺癌（prostate cancer，PCa）的病理特征及其临床意义。方法回顾性分析在广崎大学接受RCP的431例肌层浸润性膀胱癌患者的临床和病理资料。其中，我们重点关注了237例男性患者，这些患者在RCP之前进行了前列腺特异性抗原（PSA）测量和直肠指检（DRE）。显著PCa定义为前列腺标本中具有Gleason 4或5模式、病理T3或更高分期、淋巴结受累或三个或更多个多灶性病变的肿瘤。我们比较了临床显著和不显著的PCa。结果43例（18.1%）患者经RCP检查确诊为偶发PCa。有临床意义的前列腺癌患者的年龄、术前PSA水平和病理T分期明显高于无临床意义的前列腺癌患者。在16名患者中发现了心尖受累，包括11名具有临床意义的PCa患者。到随访期结束时，入组患者均未发生术后生化复发或死于PCa。结论根据我们的研究结果，术前危险因素不足以准确预测临床意义的PCa。虽然在本研究中没有PCa的生化复发或临床复发，但必须考虑保留前列腺的RCP的潜在肿瘤风险。
Objectives The aim of this study was to analyze the features of incidentally detected prostate cancer (PCa) in radical cystoprostatectomy (RCP) specimens to determine their pathological characteristics and clinical significance. Methods In this retrospective study, we reviewed the clinical and pathological records of 431 consecutive patients with muscle-invasive bladder cancer who underwent RCP at Hirosaki University. Of these, we focused on 237 male patients with prostate-specific antigen (PSA) measurements and digital rectal examinations (DRE) that were recorded prior to the RCP. Significant PCa was defined as a tumor with a Gleason 4 or 5 pattern, pathological T3 or higher stage, lymph node involvement or three or more multifocal lesions within the prostate specimen. We compared clinically significant and insignificant PCa. Results In this study, a total of 43 patients (18.1%) were diagnosed with incidental PCa via RCP specimens. Age, preoperative PSA levels and pathological T stage in patients with clinically significant PCa were considerably higher than in those with insignificant cancer. Apical involvement was found in 16 patients, including 11 of those with clinically significant PCa. By the end of the follow-up period, none of the enrolled patients had a biochemical recurrence after surgery or died from PCa. Conclusion According to our findings, preoperative risk factors were not reliable enough to accurately predict clinically significant PCa. Although there was no biochemical relapse or clinical recurrence of PCa in this study, the potential oncologic risk of prostate-sparing RCP must be considered.