Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center

ABSTRACT Purpose To investigate the incidence and pathologic characteristics of prostate cancer (PCa) incidentally discovered at the time of radical cystectomy and its impact on overall survival. Materials and Methods A single center retrospective study of 762 male patients who underwent radical cystoprostatectomy from Jan 1994 to Dec 2012. Results Of all included patients, 132 (17.3%) were found to have PCa. Patients with incidental PCa had a significantly higher mean age (69.2 vs. 62.2 years, P=0.015). Among the 132 patients with PCa, prostate specific antigen (PSA) analysis was available in 76 patients (57.6%), with a median value of 1.06ng/mL, and 61 (80.3%) patients had a PSA value below 4ng/mL. Four hundred and thirty-six patients (57.1%) were successfully followed, with a median duration of 46.5 months. The overall 5-year survival rate was 62.1%, and the 5-year cancer–specific survival rate was 72%. PCa recurrence was defined by two consecutive PSA values of >0.2 ng/mL and rising, and no PCa recurrence occurred. According to a univariate analyses, incidental PCa was not associated with cancer-specific survival (P=0.192) or overall survival (P=0.493). According to univariate analyses, the overall survival of patients with PCa was not associated with prostate cancer staging, PSA value, or Gleason score (All P values>0.05). Conclusions Prostate cancer incidentally discovered at the time of radical cystectomy does not decrease overall survival. Patients with incidental PCa were older than those without. The PSA value before operation is not helpful for predicting incidental prostate cancers.摘要 研究目的 探讨根治性膀胱切除术时偶然发现的前列腺癌（prostate cancer, PCa）的发生率、病理特征及其对总生存期的影响。 材料与方法 本研究为单中心回顾性研究，纳入1994年1月至2012年12月期间接受根治性膀胱前列腺切除术的762例男性患者。 结果 纳入的全部患者中，132例（17.3%）确诊合并偶发性前列腺癌。偶发性PCa患者的平均年龄显著高于未合并该疾病者（69.2岁 vs 62.2岁，P=0.015）。在132例PCa患者中，76例（57.6%）完成了前列腺特异性抗原（prostate specific antigen, PSA）检测，其中位值为1.06ng/mL，61例（80.3%）的PSA值低于4ng/mL。436例患者（57.1%）完成了随访，中位随访时长为46.5个月。总体5年生存率为62.1%，癌症特异性5年生存率为72%。前列腺癌复发定义为连续两次PSA值>0.2ng/mL且呈上升趋势，但本研究未观察到PCa复发情况。单因素分析结果显示，偶发性PCa与癌症特异性生存期（P=0.192）及总生存期（P=0.493）均无显著关联。单因素分析同时显示，PCa患者的总生存期与前列腺癌分期、PSA值及格里森评分（Gleason score）均无显著相关性（所有P值均>0.05）。 结论 根治性膀胱切除术时偶然发现的前列腺癌并不会降低患者总生存期。偶发性PCa患者的年龄高于未合并该疾病的患者。术前PSA值无法有效预测偶发性前列腺癌。