Incidental prostate cancer diagnosed at radical cystoprostatectomy for bladder cancer: disease-specific outcomes and survival.
BACKGROUND
The current standard of care for men with muscle-invasive bladder cancer is radical cystoprostatectomy (RCP). One-third of RCP specimens demonstrate incidental prostate cancer, primarily reported in small series with limited follow-up. The aim of this study is to report mature outcomes, including patterns of failure and disease-specific recurrence rates, and survival, for a large cohort of men with incidental prostate cancer at RCP performed at a tertiary referral center.


METHODS
This retrospective study describes cancer control and survival rates for men who underwent RCP for bladder cancer and were found incidentally to have prostate cancer. Analysis of patient-, tumor-, and treatment-specific factors were analyzed for association with disease control and survival endpoints.


RESULTS
Between 2002 and 2010, 94 patients with incidental discovery of prostate cancer postRCP were identified for inclusion in this study. Forty-five patients (45%) underwent RCP for recurrent (rather than initial presentation of) bladder carcinoma. At a median follow-up of 40.3 months (71.2 months for survivors; range, 8.9-155.5 months), 42 patients were alive without recurrence and 52 patients had died (25 associated with disease). The estimated 5-year bladder cancer disease-free, urinary tract malignancy disease-free, and prostate specific antigen (PSA) relapse-free survivals were 76% [95% confidence interval (CI), 65-84%], 64% (52-74%), and 97% (79-100%), respectively. The estimated 5-year urinary tract malignancy-specific and overall survivals were 61% (49-71%) and 52% (41-62%), respectively. Univariate analysis demonstrated associations between pathologic T/N-stage and nodal ratio with bladder cancer disease-free, urinary tract malignancy disease-specific, and overall survivals, with patient age at diagnosis as an additional adverse factor associated with overall survival. Multivariate analysis confirmed pN-stage and age as independently associated with worse survival.


CONCLUSIONS
For men undergoing RCP for bladder cancer, the present study suggests that incidentally discovered prostate cancers, irrespective of pathologic stage, Gleason score, or clinical significance, do not impact 5-year disease control or survival outcomes.
Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Joshua B
JB
Kaelberer
Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Michael A
MA
O'Donnell
Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Darrion L
DL
Mitchell
Department of Pathology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Anthony N
AN
Snow
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
Sarah L
SL
Mott
Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
John M
JM
Buatti
Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Mark C
MC
Smith
Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
John M
JM
Watkins
Bladder neoplasms; Cystoprostatectomy; Prostate neoplasms
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