title: Clinicopathological Features and Prognostic Value of Incidental Prostatic Adenocarcinoma in Radical Cystoprostatectomy Specimens: A Systematic Review and Meta-Analysis of 13,140 Patients.
abstract: There is controversy in the literature about the oncologic significance of incidental prostate cancer detected at radical cystoprostatectomy for bladder cancer.
  
  
  
  An online search was done for studies reporting incidental prostate cancer in cystoprostatectomy specimens. After following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we identified a total of 34 reports containing 13,140 patients who underwent radical cystoprostatectomy for bladder cancer with no previous history of prostate cancer. A cumulative analysis was performed on the available data regarding prevalence, clinicopathological features and oncologic outcomes. RevMan, version 5.3 was used for data meta-analysis.
  
  
  
  Of the 13,140 patients incidental prostate cancer was detected in 3,335 (24.4%). Incidental prostate cancer was significantly associated with greater age (Z = 3.81, p = 0.0001, d = 0.27, 95% CI -0.14-0.68), lymphovascular invasion of bladder cancer (Z = 2.07, p = 0.04, r = 0.14, 95% CI 0.09-0.18) and lower 5-year overall survival (Z = 2.2, p = 0.03). Among patients with clinically significant and insignificant prostate cancer those with clinically significant prostate cancer significantly more frequently showed a positive finding on digital rectal examination (Z = 3.12, p = 0.002, r = 0.10, 95% CI 0-0.19) and lower 5-year overall survival (Z = 2.49, p = 0.01) whereas no effect of age was observed (p = 0.15). Of 1,320 patients monitored for biochemical recurrence prostate specific antigen recurrence, defined as prostate specific antigen greater than 0.02 ng/ml, developed in 25 (1.9%) at between 3 and 102 months.
  
  
  
  This meta-analysis suggests that incidental prostate cancer detected during histopathological examination of radical cystoprostatectomy specimens might be linked with adverse characteristics and outcomes in patients with invasive bladder cancer.
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany.
authors: Omar
authors: O
authors: Fahmy
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany.
authors: Mohd Ghani
authors: MG
authors: Khairul-Asri
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany.
authors: Tina
authors: T
authors: Schubert
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany.
authors: Markus
authors: M
authors: Renninger
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany.
authors: Arnulf
authors: A
authors: Stenzl
authors: Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia; Department of Urology, Eberhard-Karls University (TS, MR, AS, GG), Tübingen, Germany. Electronic address: georgios.gakis@med.uni-tuebingen.de.
authors: Georgios
authors: G
authors: Gakis
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D051517:Digital Rectal Examination; D006801:Humans; D033162:Incidental Findings; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen
keywords: bladder neoplasms; cystectomy; incidental findings; prostatectomy; prostatic neoplasms