Pan Jiahua, Xue Wei, Sha Jianjun, Yang Hu, Xu Fan, Xuan Hanqing, Li Dong, Huang Yiran
Department of Urology, Renji Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
PLoS One. 2014 Apr 10;9(4):e94490. doi: 10.1371/journal.pone.0094490. eCollection 2014.
To evaluate the incidence and the clinicopathological features of incidental prostate cancer detected in radical cystoprostatectomy (RCP) specimens in Chinese men and to estimate the oncological risk of prostate apex-sparing surgery for such patients.
The clinical data and pathological feature of 504 patients who underwent RCP for bladder cancer from January 1999 to March 2013 were retrospectively reviewed. Whole mount serial section of the RCP specimens were cut transversely at 3-4 mm intervals and examined in same pathological institution.
Thirty-four out of 504 patients (6.8%) had incidental prostate cancer with a mean age of 70.3 years. 12 cases (35.2%) were diagnosed as significant disease. 4 cases were found to have apex involvement of adenocarcinoma of the prostate while in 5 cases the prostate stroma invasion by urothelial carcinoma were identified (one involved prostate apex). The mean follow-up time was 46.4±33.8 months. Biochemical recurrence occurred in 3 patients but no prostate cancer-related death during the follow-up. There was no statistical significance in cancer specific survival between the clinically significant and insignificant cancer group.
The prevalence of incidental prostate cancer in RCP specimens in Chinese patients was remarkably lower than in western people. Most of the incidental prostate cancer was clinically insignificant and patient's prognosis was mainly related to the bladder cancer. Sparing the prostate apex was potentially associated with a 1.0% risk of leaving significant cancer of the prostate or urothelial carcinoma.
评估在中国男性患者根治性膀胱前列腺切除术（RCP）标本中偶然发现的前列腺癌的发病率及临床病理特征，并评估此类患者保留前列腺尖部手术的肿瘤学风险。
回顾性分析1999年1月至2013年3月期间504例行RCP治疗膀胱癌患者的临床资料和病理特征。RCP标本连续整块横切，间隔3 - 4毫米，在同一病理机构进行检查。
504例患者中有34例（6.8%）偶然发现前列腺癌，平均年龄70.3岁。12例（35.2%）被诊断为有临床意义的疾病。4例发现前列腺腺癌累及尖部，5例发现尿路上皮癌侵犯前列腺基质（1例累及前列腺尖部）。平均随访时间为46.4±33.8个月。3例患者出现生化复发，但随访期间无前列腺癌相关死亡。临床有意义和无意义的癌症组之间的癌症特异性生存率无统计学差异。
中国患者RCP标本中偶然发现的前列腺癌患病率显著低于西方人。大多数偶然发现的前列腺癌临床意义不大，患者的预后主要与膀胱癌有关。保留前列腺尖部可能有1.0%的风险遗留有临床意义的前列腺癌或尿路上皮癌。
