Incidental prostatic adenocarcinoma in patients with PSA less than 4 ng/ml undergoing radical cystoprostatectomy for bladder cancer in iranian men

ABSTRACT

OBJECTIVE:To assess the incidence of prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer in Iranian men. MATERIALS AND METHODS: Fifty cystoprostatectomy specimens removed due to bladder malignancy (2004-2005) at two referral centers (Shaheed Modarress and Shaheed Labbafinejad Hospitals, Tehran, Iran) were examined for the coincidental finding of prostate cancer (PCa). At the time of surgery the patient's serum PSA was less than 4 ng/mL and there were no suspicious lesions by digital rectal examination. Pathologic grade, stage, morphometric volume, number of tumor foci and association with areas of high grade prostatic intraepithelial neoplasia (HGPIN) were assessed by light microscopy. All specimens were totally embedded and whole-mounted. Clinically significant cancers were defined as tumors with 0.5 mL volume, Gleason pattern 4 or 5, pT3, positive surgical margin, and multifocality > 3. RESULTS: Incidentally detected cancer was found in 7 (14 percent) of cystoprostatectomy specimens. HGPIN was present in 1 (14.3 percent) of the cystoprostatectomies with incidentally detected prostate cancer. None of cystoprostatectomies without prostate cancer had HGPIN. Four (57 percent) of the detected cancers were significant. CONCLUSION: We conclude that incidentally detected prostate cancer in Iran is lower than the rates reported in other countries. Further studies are warranted for better declaration of variability of prostate cancer between different ethnic groups.