Introduction: Incidental prostate cancer remains poorly understood, with incidences varying greatly in the literature, mainly according to the surgical procedure leading to the diagnosis. Therapeutic management of incidental prostate cancer remains a matter of controversy.
Aims: to analyze the incidence of incidental prostate cancer, its clinical characteristics, its natural history and its actual therapeutic management in a tertiary care center.
Materials & methods: Retrospective analysis of patients undergoing radical cystectomy (RC) for bladder cancer or open prostatectomy (OP) or transurethral resection (TUR) for benign prostatic enlargement, at our institution, from March 2008 to February 2012. Clinical data was analyzed by two independent urologists, in accordance with previously defined inclusion criteria. A third urologist subsequently analyzed the resulting data, to confirm the diagnosis of incidental prostate cancer.
Results: A total of 41 incidental prostate cancers were identified, 13/72 RC (18,1%), 11/292 OP (3,77%) and 17/673 TUR (2,53%). Median age at diagnosis was 72years. Histology, according to the ISUP grading system, was grade 1 in 85,4%, grade 2 in 9,8%, grade 4 in 2,4% and grade 5 in 2,4%. T staging, was T1a in 29,3%, T1b in 39%, T2a in 17,1%, T2c in 12,2% and T3a in 2,4%. Median PSA at diagnosis was 5,94ng/ml. According to the EAU risk groups, 54,5% of patients were low-risk, 31,8% intermediate-risk and 13,6% high-risk. 25,9% of patients were deceased before completing 5years of follow-up, none of which from prostate cancer. Considering patients undergoing OP or TUR for benign prostatic enlargement, the subsequent treatment option was watchful waiting (WW) in 54,6% of patients, external beam radiation therapy (EBRT) in 22,7%, androgen deprivation therapy (ADT) in 13,6% and radical prostatectomy (RP) in 9,1%. The need for a different treatment option was present in 33,3% of patients starting on WW, 40% of patients starting on EBRT, 0% of patients starting on ADT and 50% of patients starting on RP. 5% of patients were deceased before completing 5years of follow-up. Considering patients undergoing RC for bladder cancer, the subsequent treatment option was WW in 100% of patients and 85,7% of patients were deceased before completing 5years of follow-up.
Conclusions: Most patients with incidental prostate cancer were diagnosed with ISUP grade 1 and low-risk prostate cancer. A considerable number of patients were managed with WW.
