Incidental prostate cancer: A clinicopathological study

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Zhonghua Nan Ke Xue. 2021 Feb;27(2):145-149.


OBJECTIVE: To investigate the clinicopathological characteristics and prognosis of incidental prostate cancer (PCa).

METHODS: We retrospectively analyzed the clinical data and pathological characteristics of 96 cases of incidental PCa in 580 patients undergoing radical cystectomy and followed them up for prognosis.

RESULTS: The incidence rate of incidental PCa was 16.6% (96/580). The patients were 42-90 years old, with a median age of 73 years, 6 (6.2%) ≤60 and 90 (93.8%) over 60 years old. The average maximum diameter of the tumor was about 3.5 cm (range 1.0-9.0 cm). Histologically, 86 (89.6%) of the bladder cancer cases were high-grade invasive urothelial carcinoma (7 with squamous differentiation, 2 with sarcomatoid differentiation, 4 with glandular differentiation, and 1 with plasmacytoid/diffuse variant) and 7 were low-grade urothelial carcinoma, of which 1 case was poorly differentiated neuroendocrine carcinoma and 2 cases were bladder adenocarcinoma, including 1 case of signet ring cell carcinoma. All the PCa cases were classified as the histopathological type of classic acinar adenocarcinoma of the prostate, 67 (69.8%) with a Gleason score ≤ 6, and 29 (30.2%) with a Gleason score ≥ 7. Of the total number of incidental PCa cases, 32 (33.3%) were of clinical significance, and 59 (61.5%) of the patients were followed up for 1-95 (mean 28.7) months, during which 42 (71.2%) survived and 17 (28.8%) died, including 2 deaths due to non-cancer factors. No statistically significant difference was found in the median survival time between the 5 clinically significant and 10 non-clinically significant cases (P = 0.322).

CONCLUSIONS: There is a high probability of incidental PCa among bladder cancer patients aged >60 years. Standardized sampling plays an important role in detection of the malignancy. There is only a small proportion of incidental PCa cases with clinical significance, and therefore it affects less the prognosis than bladder cancer.