Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimens
- 7 February 2007
- journal article
- Published by Wiley in BJU International
- Vol. 99 (3), 554-558
- https://doi.org/10.1111/j.1464-410x.2006.06660.x
Abstract
OBJECTIVES To investigate the relationship between prostate-specific antigen (PSA) level and tumour volume for incidental adenocarcinoma of the prostate found in cystoprostatectomy (CP) specimens, and to analyse the incidence of clinically significant prostate cancers in CP specimens and the biochemical recurrence of incidental prostate cancers on short-term follow up. PATIENTS AND METHODS Complete data from 97 of 105 prostates from CP specimens were available. Prostates were thoroughly analysed and sectioned at 2 mm intervals. PSA levels and the findings at digital rectal examination before surgery were obtained prospectively. None of the patients had any evidence of prostate cancer before CP. RESULTS Incidental prostate cancer was detected in 58 of 97 (60%) of the CP specimens; of these, 31 (53%) were significant according to the definition of Stamey et al. There was a weak correlation between tumour volume and PSA level, weighted solely by the four larger-volume cancers. The median PSA level for patients with and without prostate cancer was not significantly different (3.1 vs 1.1 ng/mL, P = 0.06). The follow-up of the 35 patients alive with prostate cancer showed four PSA recurrences (PSA >0.02 ng/mL) with one distant metastasis after a median follow-up of 3 years. None of the patients with insignificant tumours developed biochemical recurrence. CONCLUSIONS The weak correlation between PSA level and tumour volume in these patients supports the argument that PSA is largely produced by benign prostatic hyperplasia and is therefore a poor screening tool for asymptomatic healthy men. Most incidental prostate cancers in CP specimens are significant, contrary to previous analyses, but have little practical importance in terms of oncological outcome.Keywords
This publication has 32 references indexed in Scilit:
- Sensitivity and Detection Rate of a 12-Core Trans-Perineal Prostate Biopsy: Preliminary ReportEuropean Urology, 2006
- Outcome of Patients with Fortuitous Prostate Cancer after Radical Cystoprostatectomy for Bladder CancerEuropean Urology, 2005
- HIGHER THAN EXPECTED ASSOCIATION OF CLINICAL PROSTATE AND BLADDER CANCERSJournal of Urology, 2005
- Pathologic characterization of prostate cancers with a very low serum prostate specific antigen (0–2 ng/mL) incidental to cystoprostatectomy: is PSA a useful indicator of clinical significance?Urologic Oncology, 2004
- Incidence and Location of Prostate and Urothelial Carcinoma in Prostates From Cystoprostatectomies: Implications for Possible Apical Sparing SurgeryJournal of Urology, 2004
- PREOPERATIVE SERUM PROSTATE SPECIFIC ANTIGEN LEVELS BETWEEN 2 AND 22 NG./ML. CORRELATE POORLY WITH POST-RADICAL PROSTATECTOMY CANCER MORPHOLOGY: PROSTATE SPECIFIC ANTIGEN CURE RATES APPEAR CONSTANT BETWEEN 2 AND 9 NG./ML.Journal of Urology, 2002
- PREOPERATIVE SERUM PROSTATE SPECIFIC ANTIGEN LEVELS BETWEEN 2 AND 22 NG./ML. CORRELATE POORLY WITH POST-RADICAL PROSTATECTOMY CANCER MORPHOLOGY:Journal of Urology, 2002
- PROSTATE CANCER IS HIGHLY PREDICTABLE:Journal of Urology, 2000
- The definition and preoperative prediction of clinically insignificant prostate cancerJAMA, 1996
- Latent carcinoma of the prostateThe Journal of Pathology and Bacteriology, 1954