Preservation of prostate during radical cystectomy: Evaluation of prevalence of prostate cancer associated with bladder cancer

Abstract Objectives To estimate the frequency and characteristics of prostatic lesions discovered incidentally in radical cystoprostatectomy specimens and to determine whether any factors would allow for the detection of prostate cancer preoperatively. Methods A total of 100 radical cystoprostatectomy specimens with orthotopic bladder reconstruction were performed for malignant bladder disease between 1990 and 2000. The mean patient age at surgery was 62 ± 8 years (range 32 to 75). Digital rectal examination and prostate-specific antigen (PSA) assay were done routinely before surgery. During the 10-year study period, the same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens using McNeal’s technique on fine slices every 2.5 mm. Results The overall incidence of prostate cancer discovered incidentally in radical cystoprostatectomy specimens was 51%, of which 29% were microcancers (volume less than 0.5 cm 3 ) and 22% were significantly larger (volume 0.5 cm 3 or more). The mean Gleason score was 6. Of the tumors, 24% could be considered “clinically nonsignificant” (less than 0.5 cm 3 and Gleason score less than 7). The mean preoperative PSA level was 4.13 ± 1.36 ng/mL. Of 66 patients with a PSA level of less than 4 ng/mL (mean PSA 1.5 ± 0.8) and a normal digital rectal examination before surgery, 50% had prostate cancer, of which 69% were microcancers. Conclusions The prevalence of prostate cancer (51%) in our series is among the highest in published reports. Furthermore, our results stress that currently no factors are available to enable the detection of “clinically significant” prostate cancer preoperatively.