Clinicopathologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence-based analysis

Objectives: To review all relevant features of incidentally discovered prostate cancer (PCa) in patients undergoing radical cystectomy for bladder cancer: incidence, pathologic characteristics, clinical signifi- cance, and implications for its management. Methods: A structured literature review through a MEDLINE search was performed. Results: The frequency of incidentally discovered PCa in cystoprostatec- tomy specimens is extremely variable because of several factors, particu- larly the pathology sampling. The relationship among clinically, incidentally, and autopsy-detected cancer is uncertain. The definition of clinically significant cancer varies among published reports and remains inadequate for clinical application. High-grade prostatic intraepithelial neoplasia is a marker for concurrent PCa and the risk depends more on the volume than on its absolute presence. Outcome of patients with unsus- pected PCa after cystoprostatectomy relies mostly on the bladder tumor. Conclusions: Incidental PCa in patients with bladder cancer is highly variable and with an unclear clinical significance. For those who are candidates for prostate-sparing surgery, it seems reasonable to include a routine prostate biopsy in the standard preoperative work-up irrespec- tive of prostate-specific antigen values. In the absence of sufficient data to make firm recommendations, when PCa is incidentally discovered, PCa surveillance should be part of the follow-up scheme after radical cystectomy.