Ces Urol 2020, 24(1):42-50 | DOI: 10.48095/cccu2020001

Incidence of prostate cancer in radical cystoprostatectomy specimen. Histopathological characteristics of tumor and the influence of the method of histological processing on the occurrence of incidental prostate cancer

Vladimír Šámal^1,2, Igor Richter³, Vít Paldus¹, Tomáš Jirásek⁴, Jan Mečl¹

¹ Urologické oddělení, Krajská nemocnice Liberec, a. s., Liberec

² Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové

³ Onkologické oddělení, Krajská nemocnice Liberec, a. s., Liberec

⁴ Oddělení patologie, Krajská nemocnice Liberec, a. s., Liberec

Šamal V, Richter I, Paldus V, Jirásek T, Mečl J. Incidence of prostate cancer in radical cystoprostatectomy specimen. Histopathological characteristics of tumor and the influence of the method of histological processing on the occurrence of incidental prostate cancer.

Aim: Radical cystoprostatectomy (RCP) as a surgical procedure in the treatment of invasive bladder cancer requires a high degree of radicality. Surgical techniques sparing prostate apex or capsule involve the risk of residual urothelial carcinoma or incidental prostate cancer (IKP). The aim of this work is to assess the occurrence, histopathological characteristics of IKP and the influence of the method of histological preparation processing on the occurrence of IKP.

Material and methods: A group of 91 patients after RCP were evaluated retrospectively, with procedures performed from January 2009 to August 2019. In 42 patients the prostate was evaluated by the block method, in 49 patients the whole-mount section (WMS). The work assessed the histopathological characteristics of IKP. Criteria for non-significant IKP determination: Gleason score ≤ 6, organ-limited disease (no extracapsular extension, no seminal vesicle invasion, NO), tumor size ≤ 0.5 cm³.

Results: One patient was excluded from the evaluation. The overall incidence of IKP was 24.4%. With the WMS processing method the incidence was 43.8 %, while with the processing blocks method it was only 2.4 %. Localized IKP was 95.5 %, 72.7 % of cases had GS ≤ 6. The average tumor volume was 1.90 ± 3.50 cm³. Ten tumors (45.5 %) were evaluated as non-significant IKP. Statistically significant difference between significant / non-significant IKP was only in tumor volume, 3.40 ± 4.25 cm³ vs 0.10 ± 0.10cm³, p = 0.021. There was also a significant difference between GS ≤ 6 vs, GS> 7 and tumor significance (p = 0.012) and between number of tumors with volume ≤ 0.5 cm³ and tumor significance, 3 vs. 10 tumors (p = 0.0000). The median follow-up was 19.5 months, with no clinical manifestation of IKP and no need to start treatment.

Conclusion: In our cohort the method used to prepare a histological specimen has a significant effect. Using the WMS technique, the IKP capture was significantly higher.

Keywords: Incidental, prostate cancer, bladder cancer, significant.

Received: October 21, 2019; Revised: November 21, 2019; Accepted: January 6, 2020; Prepublished online: January 6, 2020; Published: March 19, 2020