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

  • Shulin Wu
  • Sharron X. Lin
  • Min Lu
  • Alexander O. Subtelny
  • Zongwei Wang
  • Douglas M. Dahl
  • Aria F. Olumi
  • Chin-Lee WuEmail author
Urology - Original Paper

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.

Keywords

Bladder cancer Incidental prostate cancer Cystoprostatectomy Prognosis Androgen receptor 

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

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that there is no conflict of interest.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and subsequent amendments or comparable ethical standards.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Urology and Pathology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of PathologyPeking University Health Science CenterBeijingChina
  3. 3.Division of Urologic Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA

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