Preoperative findings, pathological stage PSA recurrence in men with prostate cancer incidentally detected at radical cystectomy: our experience in 242 cases.

Abstract

PURPOSE:

Preoperative findings, pathological stage PSA recurrence in patients with prostate cancer incidentally detected (iPCa) at radical cystectomy (RCP) were prospectively evaluated.

METHODS:

From July 2000 to July 2013, 242 men 71 years old (median) underwent RCP; preoperatively, all patients underwent digital rectal examination (DRE), total and free/total PSA. The bladder was totally examined; moreover, the prostate gland was step-sectioned at 4-mm intervals. The incidence of iPCa that fulfilled criteria for clinically significant iPCa was recorded: tumor volume ≥0.5 mL, Gleason grade ≥4, extracapsular extension, seminal vesicle invasion, lymph node metastasis or positive surgical margins. In the presence of iPCa, the patients underwent PSA evaluation during the follow-up and recurrence was defined as two subsequent rises >0.2 ng/mL.

RESULTS:

Among the 50 (20.6%) out of 242 patients submitted to RCP, an iPCa was found and 18 (36%) of them met criteria for insignificant iPCa; moreover, 30% of the patients had apex involvement. Median total PSA and PSA F/T values were not significantly different in the presence versus the absence of iPCa (2.6 vs 2.7 ng/mL and 26 vs 27%; p > 0.05) and between significant versus insignificant iPCa (p > 0.05). None of the patients during the follow-up (median 58 months; range 6-102 months) had PSA recurrence.

CONCLUSIONS:

PSA and PSA F/T values are provided for poor accuracy in distinguishing preoperatively significant from insignificant iPCa; however, the life expectancy of the patients is dramatically influenced by bladder cancer pTN (in our series, none developed PSA failure). In younger men in whom a prostate-sparing cystectomy could be proposed, an accurate preoperative evaluation should be mandatory to rule out significant iPCa at the risk of apex involvement (in our series equal to 30% of the cases).

• Authors: Pietro Pepe, Filippo Fraggetta, Antonio Galia, Paolo Panella, Michele Pennisi, Maurizio Colecchia, Francesco Aragona
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 46 Issue 7 Pg. 1325-8 (Jul 2014) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 24488687 (Publication Type: Journal Article)

Chemical References

• Prostate-Specific Antigen

Topics

• Aged
• Aged, 80 and over
• Cystectomy
• Humans
• Incidental Findings
• Male
• Middle Aged
• Neoplasm Invasiveness
• Neoplasms, Multiple Primary (epidemiology, surgery)
• Preoperative Period
• Prospective Studies
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (blood, pathology)
• Urinary Bladder Neoplasms (epidemiology, surgery)