Introduction:Radical cystoprostaectomy is the most effective treatment option for muscle invasive bladder cancer . Cystoprostatectomy specimen provides a unique opportunity to estimate the prevalence and to define the morphological features of silent adenocarcinoma of the prostate.
Aim:To determine histopathological features of silent prostate carcinoma detected in radical cystoprostatectomy specimens taken for muscle invasive bladder cancer.
Materials and Methods: A retrospective review of patients who underwent radical cystoprostatectomy for infiltrating bladder tumors during the period between 2003 and April 2014 was done. The histopathology slides of these patients were reviewed.
Results: Fourteen incidental prostate cancers were identified in 113 radical cystoprostatectomies. The mean patient’s age was 65 years (range 48-75 years). The median Gleason Score was 3+3 (3+3, 4+3). Nine patients (64%) had Gleason 6 and five (36%) had Gleason 7 disease. In our study majority of patients (64%) had low-grade disease with GS 3+3. On basis of the criteria to define significant tumour by Ohori et al., and Epstein et al., 64% of all tumours were significant in our study.
Pelvic lymph node metastasis from prostate adenocarcinoma was detected in four patients(28%). On mean follow up of 2.5 years for three patients with node positive disease there was no evidence of biochemical recurrence. For patients with node negative disease, six patients had no evidence of recurrence on a follow up of 3.5 years.
Conclusion:The silent adenocarcinoma prostate has significant incidence in cyotoprostatectomy specimen with majority of tumors being low grade .These silent prostate adenocarcinoma lesions show presence of clinically significant disease and even one fourth of lesions showing nodal metastasis .It would be prudent to do digital rectal examination (for clinical prostate evaluation) and Prostate-Specific Antigen (PSA) testing along with bladder cancer work up.