Original contributionIncidentally detected prostate cancer in cystoprostatectomies: pathological and morphometric comparison with clinically detected cancer in totally embedded specimens
Introduction
Prostate cancer is identified in 3 different settings: (1) clinically diagnosed by physical examination, laboratory tests, and/or symptoms (clinically detected cancer); (2) discovered when the prostate is removed incidentally (eg, during cystoprostatectomy for bladder cancer) (incidentally detected cancer); or (3) discovered latently at autopsy without ever having caused symptoms during the person's lifetime (autopsy-detected cancer). The incidence of prostate cancer in each of these settings is different.
The lifetime risk of clinically detected prostate cancer is 9.5%, and the probability of dying from prostate cancer is 3%. The frequency of incidentally detected cancer is approximately 42% in men older than 50 years; the frequency of autopsy-detected cancer is similar or higher. Early diagnosis of lethal prostate cancer is a laudable goal, as is avoidance of unnecessary treatment, but current methods are inaccurate for making this determination. In no other malignancy is there such a vast reservoir of undetected cases that may never be clinically significant or cause death [1]; yet, we are unable to stratify significant and insignificant cancer.
Almost all clinical and morphological studies of prostate cancer have been made in biopsy and radical prostatectomy specimens, representing clinically detected cancer [2], [3], [4], [5], [6], [7]. Currently, stage, surgical margin status, and Gleason score are the most commonly used predictors of outcome for patients with prostate cancer in radical prostatectomy specimens.
Removal of the prostate with the bladder during radical cystectomy for bladder cancer provides a unique opportunity to evaluate the clinical and morphological features of incidentally detected prostate cancer [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]. To our knowledge, there are no previous studies that compare the morphological, morphometric, and immunohistochemical features of benign prostate, high-grade prostatic intraepithelial neoplasia (PIN), and cancer in cystoprostatectomy and radical prostatectomy specimens; this was the aim of the current study.
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Morphology
The study group materials were obtained from the files of the Section of Pathological Anatomy and Histopathology of the Polytechnic University of the Marche Region, Ancona, Italy. A total of 360 consecutive prostate specimens were examined between March 1997 and June 2001 and consisted of the following:
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One hundred thirty-two cystoprostatectomy specimens from men with urothelial carcinoma and no history or clinical evidence of prostate cancer before surgery. Mean patient age was 61 years (range,
Morphology
The majority (67%) of clinically detected cancers were pT2b and pT3a (32% and 35%, respectively) (Table 1). A total of 21% and 59% of cases had Gleason scores 6 and 7, respectively (Table 2). Positive margins were present in 52% of specimens, and regional lymph node metastases were present in 2% of cases.
Incidentally detected prostate cancer was present in 42% of cystoprostatectomy specimens. The majority (60%) was pT2a and 28% pT2b, with lower frequency in other pT categories (8% pT3a, 3%
Discussion
We found that 42% of totally sampled cystoprostatectomy specimens with bladder cancer also contained incidental prostate cancer. This result was identical to the overall mean frequency of incidentally detected prostate cancer in other series of cystoprostatectomy cases (range, 23%-68%) [1], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] and similar to or slightly lower than the age-adjusted frequency of autopsy-detected prostate cancer (mean
Acknowledgments
This report was supported by grants from the Polytechnic University of the Marche Region (Ancona) Italy (M. S.) and the Italian Ministry of University and Scientific Research (R. M., 2003). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Polytechnic University of the Marche Region (Ancona, Italy).
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