1
|
Matoso A, Epstein JI. Defining clinically significant prostate cancer on the basis of pathological findings. Histopathology 2019; 74:135-145. [PMID: 30565298 DOI: 10.1111/his.13712] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
The definition of clinically significant prostate cancer is a dynamic process that was initiated many decades ago, when there was already evidence that a great proportion of patients with prostate cancer diagnosed at autopsy never had any clinical symptoms. Autopsy studies led to examinations of radical prostatectomy (RP) specimens and the establishment of the definition of significant cancer at RP: tumour volume of 0.5 cm3 , Gleason grade 6 [Grade Group (GrG) 1], and organ-confined disease. RP studies were then used to develop prediction models for significant cancer by the use of needle biopsies. The first such model was used to delineate the first active surveillance (AS) criteria, known as the 'Epstein' criteria, in which patients with a cancer Gleason score of 3 + 3 = 6 (GrG1) involving fewer than two cores, and <50% of any given core, and a prostate-specific antigen density of <0.15 ng/ml per cm3 had a minimal risk of significant cancer at RP. These were adopted as components of the 'very-low-risk category' of the National Comprehensive Cancer Network guidelines, in which AS is supported as a management option. With the increase in the popularity of AS, much research has been carried out to better define significant/insignificant cancer, in order to be able to safely offer AS to a larger proportion of patients without the risk of undertreatment. Research has focused on allowing higher volume tumours, focal extraprostatic extension, and a limited amount of Gleason pattern 4, and the significance of different morphological patterns of Gleason 4. Other areas of research that will probably impact on the field but that are not covered in this review include the molecular classification of tumours and imaging techniques.
Collapse
Affiliation(s)
- Andres Matoso
- Departments of Pathology, Urology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| |
Collapse
|
2
|
Jønck S, Helgstrand JT, Røder MA, Klemann N, Grønkaer Toft B, Brasso K. The prognostic impact of incidental prostate cancer following radical cystoprostatectomy: a nationwide analysis. Scand J Urol 2019; 52:358-363. [PMID: 30624125 DOI: 10.1080/21681805.2018.1534885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To determine the prevalence and prognostic impact of incidental prostate cancer in patients undergoing radical cystoprostatectomy. METHODS A nationwide population-based study of incidental prostate cancer diagnosed following radical cystoprostatectomy. Information on vital status, Gleason score, positive and negative tumor margins, pT-category and subsequent prostate cancer therapies were obtained from the Danish Prostate Cancer Registry and by manual chart review. RESULTS A total of 1,450 men who underwent radical cystoprostatectomy in Denmark from 1995-2011 were identified. Forty-six men were excluded from analysis, thus 1,404 patients were eligible. The median follow-up was 7.8 years. A total of 466 (33.2%) had incidental prostate cancer diagnosed. No statistical differences in 10- and 15-year cumulative overall mortality were observed when comparing men with, or without, incidental prostate cancer. In men diagnosed with incidental prostate cancer, neither Gleason score, positive surgical margins or locally advanced prostate cancer (pT3-4) was associated with mortality. Only 0.9% received post-operative prostate cancer-related treatment. CONCLUSION In this population-based cohort of patients with incidental prostate cancer diagnosed at radical cystoprostatectomy, we found no impact of incidental prostate cancer on overall mortality, regardless of Gleason score, surgical margin status and pathological T-category. Patients diagnosed with incidental prostate cancer following radical cystoprostatectomy are unlikely to benefit from additional follow-up.
Collapse
Affiliation(s)
- Simon Jønck
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - John Thomas Helgstrand
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Martin Andreas Røder
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Nina Klemann
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Birgitte Grønkaer Toft
- b Department of Pathology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Klaus Brasso
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| |
Collapse
|
3
|
Tanaka T, Koie T, Ohyama C, Hashimoto Y, Imai A, Tobisawa Y, Hatakeyama S, Yamamoto H, Yoneyama T, Horiguchi H, Kodama H, Yoneyama T. Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy. Jpn J Clin Oncol 2017; 47:1078-1082. [DOI: 10.1093/jjco/hyx119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Toshikazu Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
4
|
Lopez-Beltran A, Cheng L, Montorsi F, Scarpelli M, Raspollini MR, Montironi R. Concomitant bladder cancer and prostate cancer: challenges and controversies. Nat Rev Urol 2017; 14:620-629. [DOI: 10.1038/nrurol.2017.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
5
|
Clinicopathological Features and Prognostic Value of Incidental Prostatic Adenocarcinoma in Radical Cystoprostatectomy Specimens: A Systematic Review and Meta-Analysis of 13,140 Patients. J Urol 2017; 197:385-390. [DOI: 10.1016/j.juro.2016.08.088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
|
6
|
Qarro A, Ammani A, Bazine K, Najoui M, Samir J, Alami M. Synchronous primary malignancies of the male urogenital tract. Can Urol Assoc J 2014; 8:E353-5. [PMID: 24940463 DOI: 10.5489/cuaj.1532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The finding of prostate cancer after a cystoprostatectomy for a bladder tumour can occur in up to 70% of cases. The incidence of prostate cancer in patients with a bladder tumour is 18 times higher than in the general population; moreover, the incidence of bladder cancer in patients with prostate cancer is 19 times higher than in the general population. This association can be explained by the common embryological origin of these organs, with molecular similarities. Other similarities between these two cancers are noted. They are multifocal and may be secondary to urinary stasis. However, this association does not seem responsible for an increased risk of progression of both diseases. The prognosis is related to the extension of each cancer. The stage and grade of bladder cancer are, in terms of prognosis, greater than those of prostate cancer. Most often, this is insignificant prostate cancer. Despite this, the prostate-specific antigen test should be administered to monitor patients after cystoprostatectomy.
Collapse
Affiliation(s)
| | - Abdelghani Ammani
- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco
| | - Khalil Bazine
- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco
| | - Mohammed Najoui
- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco
| | - Jamaleddine Samir
- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco
| | - Mohammed Alami
- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco
| |
Collapse
|
7
|
Muto G, Collura D, Rosso R, Giacobbe A, Muto GL, Castelli E. Seminal-sparing Cystectomy: Technical Evolution and Results Over a 20-Year Period. Urology 2014; 83:856-61. [DOI: 10.1016/j.urology.2013.08.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/29/2013] [Accepted: 08/17/2013] [Indexed: 10/25/2022]
|
8
|
Pepe P, Fraggetta F, Galia A, Panella P, Pennisi M, Colecchia M, Aragona F. Preoperative findings, pathological stage PSA recurrence in men with prostate cancer incidentally detected at radical cystectomy: our experience in 242 cases. Int Urol Nephrol 2014; 46:1325-8. [DOI: 10.1007/s11255-014-0647-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/16/2014] [Indexed: 11/29/2022]
|
9
|
Bruins HM, Djaladat H, Ahmadi H, Sherrod A, Cai J, Miranda G, Skinner EC, Daneshmand S. Incidental Prostate Cancer in Patients with Bladder Urothelial Carcinoma: Comprehensive Analysis of 1,476 Radical Cystoprostatectomy Specimens. J Urol 2013; 190:1704-9. [DOI: 10.1016/j.juro.2013.05.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Harman Maxim Bruins
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| | - Hamed Ahmadi
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| | - Andy Sherrod
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| | - Jie Cai
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| | - Gus Miranda
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| | | | - Siamak Daneshmand
- Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, California
| |
Collapse
|
10
|
|
11
|
Champy CM, Phé V, Drouin SJ, Comperat E, Parra J, Vaessen C, Mozer P, Bitker MO, Rouprêt M. [Prognostic influence of prostate gland invasion by bladder tumour and/or prostate cancer in cystoprostatectomy specimen: a review]. Prog Urol 2013; 23:165-70. [PMID: 23446280 DOI: 10.1016/j.purol.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/06/2012] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cystoprostatectomy (CPT) is the gold standard surgical treatment for muscle invasive bladder cancer (MIBC). In certain cases, MIBC can invade the prostate gland and/or a prostate cancer (PCa) can be discovered fortuitously on the pathologic specimen. The aim of the current study was to report the prognostic influence of PCa in patients who underwent a CPT for MIBC. MATERIALS AND METHODS A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: prostatic neoplasm; urinary bladder neoplasm; cystectomy; surgery; recurrence; prognosis; survival. Clinical cases and series of less than five cases were deliberately excluded herein. RESULTS Overall, ten studies published between 2004 and 2011 and involving 2196 patients were selected. Only retrospective studies of low level of evidence (NP 4) were available. The incidence of neoplastic invasion of the prostate gland by MIBC ranged from 25 to 48%. Preoperative predictors were multiple BC, recurrent, location in the trigone and existence of CIS. Overall survival at 3 years was significantly affected by the invasion of the prostate gland (pT4a) in these patients. The incidence of PCa discovered incidentally pathologic specimen CPT ranged from 14 to 49%. Only age was found as a positive predictor. The diagnosis of PCa did not influence survival of patients with MIBC and no specific PCa adjuvant treatment was systematically advocated. CONCLUSION Fortuitous diagnosis of PCa and/or neoplastic invasion of the prostatic gland by BC on CPT specimen is not uncommon but this is variable across studies, depending on the quality of the pathological analysis. The invasion of the prostate gland by MIBC is a serious situation (pT4a) and linked with a poor prognosis. In case of concomitant PCa and MIBC, the prognosis is much more related to the natural history of the bladder tumour.
Collapse
Affiliation(s)
- C M Champy
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75013 Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Ahmadi N, Delprado WJ, Brooks AJ, Brenner PC, Coombes GM, Grant A, Patel MI. Cancer identified incidentally in the prostate following radical cystoprostatectomy: an Australian study. ANZ J Surg 2012; 84:473-6. [DOI: 10.1111/ans.12015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 01/20/2023]
Affiliation(s)
- Nariman Ahmadi
- Urological Cancer Outcomes Centre; Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | | | - Andrew J. Brooks
- Westmead Hospital; The University of Sydney; Sydney New South Wales Australia
| | | | - Graham M. Coombes
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | | | - Manish I. Patel
- Urological Cancer Outcomes Centre; Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
13
|
Potentially clinically relevant prostate cancer is found more frequently after complete than after partial histopathological processing of radical cystoprostatectomy specimens. Virchows Arch 2012; 461:655-61. [DOI: 10.1007/s00428-012-1328-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/03/2012] [Accepted: 09/29/2012] [Indexed: 11/25/2022]
|
14
|
Incidentally found prostate cancer and influence on overall survival after radical cystoprostatectomy. Prostate Cancer 2012; 2012:690210. [PMID: 22701798 PMCID: PMC3372048 DOI: 10.1155/2012/690210] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 11/18/2022] Open
Abstract
Objectives. To determine incidentally found prostate cancer frequency and impact on overall survival after RCP. Patients and Methods. The records of 81 men who underwent cystoprostatectomy from January 2000 to December 2009 were reviewed. The vital status of the study group was assessed as on September 1, 2009, by passive followup, using data from the population registry. Results. The 81 men underwent RCP. The incidental prostate cancer was found in the specimens of 27 (33.3%) patients. 13 (48.1%) of 27 prostate cancer cases were clinically significant. For 3 patients (11.1%) an extraprostatic extension was found. For 2 patients (7.4%)—positive margins, for 1 patient (3.7%)—Gleason sum 8, and for the rest 7 patients bigger than 0.5 cm3 volume tumor, and Gleason sum 7 was found. The mean follow-up time was 39.2 ± 33.8 months (varies from 0.8 to 131.2 months). The patients with bladder cancer and incidentally found prostate cancer lived shorter (28.1 ± 27.5 and 45.5 ± 35.40 months). Higher overall survival (P = 0.03) was found in the patient group with bladder cancer without incidentally diagnosed prostate cancer. Conclusion. There are indications that in this small study prostate cancer has influenced on patients' survival with bladder cancer after radical cystoprostatectomy.
Collapse
|
15
|
Wolters T, Montironi R, Mazzucchelli R, Scarpelli M, Roobol MJ, van den Bergh RCN, van Leeuwen PJ, Hoedemaeker RF, van Leenders GJLH, Schröder FH, van der Kwast TH. Comparison of incidentally detected prostate cancer with screen-detected prostate cancer treated by prostatectomy. Prostate 2012; 72:108-15. [PMID: 21538424 DOI: 10.1002/pros.21415] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/06/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prostate may often harbor a prostate cancer (PC) which will not cause morbidity if left untreated. Screening for PC leads to increased detection of these insignificant cancers. Objective of this study is to compare PC detected by PSA screening at subsequent screening rounds and treated by radical prostatectomy (RP) with PC incidentally found in cystoprostatectomy specimens. METHODS Radical prostatectomy specimens of 617 screen-detected PC were compared with 123 PC identified in cystoprostatectomy specimens. Surgical specimens were systematically examined and stage, grade, tumor volume were recorded. Next, we classified PC as clinically significant or insignificant (i.e., tumor volume <0.5 cm(3), absence of Gleason pattern 4/5, organ confined). Pathological features of incidentally detected PC were compared with PC detected in subsequent screening rounds and with screen-detected T1c PC. RESULTS Screen-detected PC overall were more often multifocal, larger in volume, more advanced in tumor stage and of higher grade, while the frequency of insignificant PC was lower as compared to those in cystoprostatectomy specimens. This effect became more pronounced during subsequent screening rounds. Screen-detected T1c PC were also more often multifocal (73% vs. 37%) in average fivefold larger (0.85 cm(3) vs. 0.16 cm(3)), less often organ confined (81% vs. 94%), and less frequently clinically insignificant (33% vs. 81%). CONCLUSIONS Screen-detected (T1c) PC treated with RP shows more aggressive features than incidentally found PC. This PSA screening-related selection seems to be mainly driven by tumor volume and-in later screening rounds-by the preferential treatment by prostatectomy of more aggressive PC.
Collapse
Affiliation(s)
- Tineke Wolters
- Department of Urology, Erasmus MC Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Aytac B, Vuruskan H. Clinicopathologic features of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens. World J Surg Oncol 2011; 9:81. [PMID: 21774802 PMCID: PMC3155901 DOI: 10.1186/1477-7819-9-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/20/2011] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study is to review all features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer. Methods The medical charts of 300 male patients who underwent radical cystoprostatectomy for bladder cancer between 1997 and 2005 were retrospectively reviewed. The mean age of the patients was 62 (range 51-75) years. Results Prostate adenocarcinoma was present in 60 (20%) of 300 specimens. All were acinar adenocarcinoma. Of these, 40 (66.7%) were located in peripheral zone, 20 (33.3%) had pT2a tumor, 12 (20%) had pT2b tumor, 22(36.7%) had pT2c and, 6 (10%) had pT3a tumor. Gleason score was 6 or less in 48 (80%) patients. Surgical margins were negative in 54 (90%) patients, and tumor volume was less than 0.5 cc in 23 (38.3%) patients. Of the 60 incidentally detected cases of prostate adenocarcinoma 40 (66.7%) were considered clinically significant. Conclusion Incidentally detected prostate adenocarcinoma is frequently observed in radical cystoprostatectomy specimens. The majority are clinically significant.
Collapse
Affiliation(s)
- Berna Aytac
- Department of Surgical Pathology, Uludag University Medical Faculty, Bursa, Turkey.
| | | |
Collapse
|
17
|
Trpkov K, Yilmaz A, Bismar TA, Montironi R. ‘Insignificant’ prostate cancer on prostatectomy and cystoprostatectomy: variation on a theme ‘low-volume/ low-grade’ prostate cancer? BJU Int 2010; 106:304-15. [DOI: 10.1111/j.1464-410x.2010.09499.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Autorino R, Di Lorenzo G, Giannarini G, Cindolo L, Lima E, De Sio M, Lamendola MG, Damiano R. LOOKING AT THE PROSTATES OF PATIENTS WITH BLADDER CANCER: A THOUGHTFUL EXERCISE. BJU Int 2009; 104:160-2. [DOI: 10.1111/j.1464-410x.2009.08476.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Kurahashi T, Miyake H, Furukawa J, Kumano M, Takenaka A, Fujisawa M. Characterization of prostate cancer incidentally detected in radical cystoprostatectomy specimens from Japanese men with bladder cancer. Int Urol Nephrol 2009; 42:73-9. [DOI: 10.1007/s11255-009-9578-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
|
20
|
Barbisan F, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Kirkali Z, Montironi R. Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int 2009; 103:1058-63. [DOI: 10.1111/j.1464-410x.2008.08207.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Autorino R, Di Lorenzo G, Damiano R, Giannarini G, De Sio M, Cheng L, Montironi R. Pathology of the prostate in radical cystectomy specimens: A critical review. Surg Oncol 2009; 18:73-84. [DOI: 10.1016/j.suronc.2008.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/20/2008] [Accepted: 07/14/2008] [Indexed: 11/27/2022]
|
22
|
|
23
|
Mazzucchelli R, Barbisan F, Scarpelli M, Lopez-Beltran A, van der Kwast TH, Cheng L, Montironi R. Is incidentally detected prostate cancer in patients undergoing radical cystoprostatectomy clinically significant? Am J Clin Pathol 2009; 131:279-83. [PMID: 19141388 DOI: 10.1309/ajcp4ocyzban9tju] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cystoprostatectomy specimens obtained from patients with bladder cancer provide a unique opportunity to assess the features of silent prostate adenocarcinoma (PCa). The whole-mount prostate sections of 248 totally embedded and consecutively examined radical cystoprostatectomy (RCP) specimens were reviewed to determine the incidence and features of incidentally detected PCa. PCa was considered clinically significant if any of the following criteria were present: total tumor volume, 0.5 cc or more; Gleason grade, 4 or more; extraprostatic extension; seminal vesicle invasion; lymph node metastasis (of PCa); or positive surgical margins. PCa was present in 123 (49.6%) of 248 specimens. Features were as follows: acinar adenocarcinoma, 123 (100.0%); peripheral zone location, 98 (79.7%); pT2a, 96 (78.0%); pT2b, 11 (8.9%); pT2c, 9 (7.3%); pT3a, 5 (4.1%); pT3b, 2 (1.6%); pT4, 0 (0.0%); Gleason score 6 or less, 107 (87.0%); negative margins, 119 (96.7%); pN0 for PCa, 123 (100.0%); and tumor volume less than 0.5 cc, 116 (94.3%). Of the 123 incidentally detected cases of PCa, 100 (81.3%) were considered clinically insignificant. Incidentally detected PCa is frequently observed in RCP. The majority are clinically insignificant.
Collapse
Affiliation(s)
- Roberta Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Francesca Barbisan
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Antonio Lopez-Beltran
- Department of Pathology, Reina Sofia University Hospital and Faculty of Medicine, Cordoba, Spain
| | - Theodorus H. van der Kwast
- Department of Pathology and Laboratory Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| |
Collapse
|
24
|
|
25
|
Saad M, Abdel-Rahim M, Abol-Enein H, Ghoneim MA. Concomitant pathology in the prostate in cystoprostatectomy specimens: a prospective study and review. BJU Int 2008; 102:1544-50. [DOI: 10.1111/j.1464-410x.2008.07831.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Zhu YP, Ye DW, Yao XD, Zhang SL, Dai B, Zhang HL, Shen YJ, Zhu Y, Shi GH. Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries. Asian J Androl 2008. [PMID: 19050682 DOI: 10.1038/aja.2008.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study is to investigate the frequency of prostate cancer (Pca) discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy (PSC) for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years (range: 32-75 years). Prostate-specific antigen (PSA) levels and digital rectal examination (DRE) results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 (3.3%) were found to have Pca; in one out of three (33.3%) patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% (64/642). When age was restricted to < 60 years, only 7 out of 222 (3.2%) patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectomy specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.
Collapse
Affiliation(s)
- Yi-Ping Zhu
- Department of Urology, Cancer Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Thomas C, Wiesner C, Melchior S, Gillitzer R, Schmidt F, Thüroff JW. Indications for Preoperative Prostate Biopsy in Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer. J Urol 2008; 180:1938-41; discussion 1941. [DOI: 10.1016/j.juro.2008.07.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Christian Thomas
- Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Christoph Wiesner
- Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | | | - Rolf Gillitzer
- Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Folke Schmidt
- Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | | |
Collapse
|
28
|
Jin XD, Chen ZD, Wang B, Cai SL, Yao XL, Jin BY. Incidental prostate cancer in radical cystoprostatectomy specimens. Asian J Androl 2008; 10:809-14. [DOI: 10.1111/j.1745-7262.2008.00420.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
29
|
Pettus JA, Al-Ahmadie H, Barocas DA, Koppie TM, Herr H, Donat SM, Dalbagni G, Reuter VE, Olgac S, Bochner BH. Risk Assessment of Prostatic Pathology in Patients Undergoing Radical Cystoprostatectomy. Eur Urol 2008; 53:370-5. [PMID: 17689003 DOI: 10.1016/j.eururo.2007.07.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the incidence and location of prostate adenocarcinoma (PCa) and prostatic urothelial carcinoma (PUC) for patients undergoing radical cystoprostatectomy (RCP) for bladder cancer and to ascertain what preoperative information may be useful in predicting PUC or PCa in patients who may be candidates for prostate-sparing cystectomy. METHODS Between 2001 and 2004, 235 consecutive patients underwent RCP and had whole-mount sections of the prostate. We reviewed our prospective radical cystectomy database for preoperative clinicopathological information associated with each patient. The bladder and whole-mount prostate sections were re-reviewed to determine the location and depth of the bladder tumor as well as the presence of any associated PCa and PUC. RESULTS We identified 113 of 235 (48%) and 77 of 235 (33%) men with PCa and PUC, respectively. Among patients with PCa, 33 (29%) had Gleason score of > or = 7, 25 (22%) had PCa tumor volume > 0.5 cc, and 15 (13%) had extracapsular extension. On multivariable analysis, only increasing age was significantly associated with PCa (odds ratio=1.3, p=0.046). Of the 77 with PUC, 28 (36%) had in situ disease only, while 49 (64%) had prostatic stromal invasion. Bladder tumor location in the trigone/bladder neck (p<0.001) and bladder carcinoma in situ (p<0.001) was strongly associated with PUC in the final specimen. Overall, 158 (67%) had either PCa or PUC in the prostate. CONCLUSIONS PCa and/or PUC is present in a majority of RCP specimens. Current preoperative staging and tumor characteristics are not adequate for determining who can safely be selected for prostate-sparing cystectomy.
Collapse
Affiliation(s)
- Joseph A Pettus
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Weizer AZ, Shah RB, Lee CT, Gilbert SM, Daignault S, Montie JE, Wood DP. Evaluation of the prostate peripheral zone/capsule in patients undergoing radical cystoprostatectomy: Defining risk with prostate capsule sparing cystectomy. Urol Oncol 2007; 25:460-4. [DOI: 10.1016/j.urolonc.2006.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 09/26/2006] [Accepted: 09/28/2006] [Indexed: 10/22/2022]
|
31
|
Damiano R, Di Lorenzo G, Cantiello F, De Sio M, Perdonà S, D'Armiento M, Autorino R. Clinicopathologic Features of Prostate Adenocarcinoma Incidentally Discovered at the Time of Radical Cystectomy: An Evidence-Based Analysis. Eur Urol 2007; 52:648-57. [PMID: 17600614 DOI: 10.1016/j.eururo.2007.06.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 06/11/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review all relevant features of incidentally discovered prostate cancer (PCa) in patients undergoing radical cystectomy for bladder cancer: incidence, pathologic characteristics, clinical significance, and implications for its management. METHODS A structured literature review through a MEDLINE search was performed. RESULTS The frequency of incidentally discovered PCa in cystoprostatectomy specimens is extremely variable because of several factors, particularly the pathology sampling. The relationship among clinically, incidentally, and autopsy-detected cancer is uncertain. The definition of clinically significant cancer varies among published reports and remains inadequate for clinical application. High-grade prostatic intraepithelial neoplasia is a marker for concurrent PCa and the risk depends more on the volume than on its absolute presence. Outcome of patients with unsuspected PCa after cystoprostatectomy relies mostly on the bladder tumor. CONCLUSIONS Incidental PCa in patients with bladder cancer is highly variable and with an unclear clinical significance. For those who are candidates for prostate-sparing surgery, it seems reasonable to include a routine prostate biopsy in the standard preoperative work-up irrespective of prostate-specific antigen values. In the absence of sufficient data to make firm recommendations, when PCa is incidentally discovered, PCa surveillance should be part of the follow-up scheme after radical cystectomy.
Collapse
Affiliation(s)
- Rocco Damiano
- Clinica Urologica, Università Magna Graecia, Catanzaro, Italy
| | | | | | | | | | | | | |
Collapse
|
32
|
Terrone C, Porpiglia F, Cracco C, Tarabuzzi R, Cossu M, Renard J, Scarpa RM, Rocca Rossetti S. Supra-ampullar Cystectomy and Ileal Neobladder. Eur Urol 2006; 50:1223-33. [DOI: 10.1016/j.eururo.2006.07.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 07/27/2006] [Indexed: 10/24/2022]
|