Many radical cystectomy (RC) patients may harbor concomitant prostate cancer (PCa), including a concerning proportion with clinically relevant disease, according to Austrian researchers.
Of 213 male patients who underwent RC at Medical University in Innsbruck over 10 years, 113 (53.1%) had PCa in the RC specimen. More than half of these (59 of 113) had Gleason score 7 disease or higher on final pathology. Gleason 4+3 disease specifically was found in 16 patients.
PCa occurred significantly more frequently in older men. The mean age of patients with PCa in the RC specimen was 69.7 years, whereas patients without PCa in the RC specimen had a mean age of 67.2 years.
Patients were diagnosed with either localized muscle-invasive bladder cancer or recurrent, high-risk non-muscle-invasive bladder cancer and underwent standard radical cystectomy, including removal of the bladder, prostate, seminal vesicles, and distal ureters, bilateral extended pelvic lymphadenectomy, and urinary diversion.
Analyses revealed that pre-operative PSA level and percentage of free PSA significantly predicted PCa occurrence, along with patient age. According to researchers Isabel Heidegger, MD, PhD, and colleagues, the findings highlight the usefulness of percentage of free PSA as an additional tool to identify patients likely to have PCa.
The investigators also discovered adverse bladder histology of pT3 or higher in 63.7% of patients with PCa. Organ border growth (pT3a and higher) was observed in 10.6% of specimens. “Adverse bladder histology is a risk factor for both PCa and biochemical PSA recurrence,” Dr Heidegger and the team stated in an online report in Urologic Oncology.
Of 53 patients available for follow up, 15 (28.3%) experienced biochemical recurrence, defined as a PSA level of 0.2 ng/mL and above. Thirteen patients had Gleason score 7 disease or higher in the RC specimen, and 2 had Gleason score 5. Furthermore, 12 of the patients with recurrence had organ-extended histology of the bladder of pT3 or above. Unlike previous studies, 6 patients with recurrence disease died from PCa rather than bladder cancer.
In light of the findings, Dr Heidegger and colleagues recommended that clinicians measure PSA during follow up of cystectomy patients, even when PCa risk is deemed low risk. In addition, “’prostate-sparing cystectomy’ should be offered only to highly selected patients without primary involvement of the prostatic urethra and without PCa including preoperative digital rectal examination and PSA measurement.”
Study limitations included the retrospective design and a high number of patients lost during post-operative follow-up visits, according to the researchers. “Therefore,the data reported here may reflect a certain selection bias in statistical interpretation and in the exclusion of patients who were followed up elsewhere,” the investigators wrote.
1. Heidegger I, Oberaigner W, Horninger W, and Pichler R. High incidence of clinically significant concomitant prostate cancer in patients undergoing radical cystectomy for bladder cancer: A 10-year single-center experience. Urol Onc. doi: 10.1016/j.urolonc.2016.11.004. [Epub ahead of print].