Department of Urology, University of Heidelberg, Heidelberg, Germany.
Int J Urol. 2013 Sep;20(9):866-71. doi: 10.1111/iju.12073. Epub 2013 Feb 4.
To describe the prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy for bladder malignancy; to quantify the association between incidental prostate cancer and mortality in these patients; and to quantify the association between incidental prostate cancer and age in radical cystoprostatectomy specimens.
Consecutive patients undergoing radical cystoprostatectomy for bladder malignancy at six academic institutions were assessed. End-points were the histological diagnosis of prostate cancer in the radical cystoprostatectomy specimens and mortality. The association between incidental prostate cancer and mortality was calculated by multivariable Cox regression, and the association between age and the occurrence of prostate cancer was calculated by logistic regression.
A total of 1122 patients (aged 65.6 ± 10 years) were included in this analysis. Prostate cancer was detected in 17.8% (n = 200) of the cystoprostatectomy specimens. After multivariable adjustment, prostate cancer was significantly associated with mortality (hazard ratio 1.27, 95% confidence interval 1.03-1.56). There was a significant association between age and the presence of prostate cancer in the cystoprostatectomy specimen. The odds ratio for the presence of prostate cancer was 1.028 (95% confidence interval 1.011-1.045; P < 0.001) per each year after the age of 40 years.
Concomitant prostate cancer is an independent prognostic factor for mortality after radical cystoprostatectomy for bladder cancer. When considering a prostate-sparing technique, urologists should consider that every fifth to sixth patient will present with a concomitant prostate cancer, and that after the age of 40 years, the odds of a concomitant prostate cancer increases by 2.8% per year, thus warranting a careful balance between the oncological risks and quality of life issues.
描述因膀胱癌接受根治性膀胱切除术患者中偶然发现的前列腺癌的患病率；量化这些患者中偶然发现的前列腺癌与死亡率之间的关联；并量化根治性膀胱切除术中偶然发现的前列腺癌与年龄之间的关联。
在六个学术机构中对因膀胱癌接受根治性膀胱切除术的连续患者进行评估。终点是根治性膀胱切除术中前列腺癌的组织学诊断和死亡率。通过多变量 Cox 回归计算偶然发现的前列腺癌与死亡率之间的关联，通过逻辑回归计算年龄与前列腺癌发生之间的关联。
共纳入 1122 例患者（年龄 65.6±10 岁）进行分析。17.8%（n=200）的膀胱切除术中检测到前列腺癌。多变量调整后，前列腺癌与死亡率显著相关（风险比 1.27，95%置信区间 1.03-1.56）。年龄与膀胱切除术中前列腺癌的存在之间存在显著关联。前列腺癌存在的比值比为 40 岁后每年增加 1.028（95%置信区间 1.011-1.045；P<0.001）。
根治性膀胱切除术后并发前列腺癌是膀胱癌患者死亡的独立预后因素。当考虑前列腺保留技术时，泌尿科医生应考虑到每五到六名患者中就会有一名并发前列腺癌，并且 40 岁后，每年并发前列腺癌的几率增加 2.8%，因此需要在肿瘤学风险和生活质量问题之间进行仔细平衡。
