Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology MedStar Georgetown University Hospital, Washington, DC, USA.
Diagn Interv Radiol. 2018 Sep;24(5):316-320. doi: 10.5152/dir.2018.18102.
In the era of multiparametric magnetic resonance imaging (mpMRI) of the prostate gland, incidental findings are occasionally discovered on imaging. We aimed to report our experience of detecting incidental bladder cancers on mpMRI of the prostate in asymptomatic patients without irritative voiding symptoms or microscopic or gross hematuria.
A retrospective review was performed on a prospectively maintained database of all men who underwent prostate mpMRI at our institution from 2012 to 2018. Patients who were found to have incidental bladder lesions were identified and baseline demographics, imaging and histopathologic data were recorded. All patients with incidental bladder lesion detection on mpMRI, not attributable to extension of prostate cancer, underwent cystoscopy in addition to a biopsy and/or transurethral resection of bladder tumor (TURBT) if warranted on cystoscopy.
There were 3147 prostate mpMRIs performed during this period and 25 cases (0.8%) of incidental bladder lesions were detected. These patients did not have any presenting symptoms such as gross or microscopic hematuria to prompt bladder lesion workup. The largest diameter of incidentally discovered bladder lesions ranged from 0.4 cm to 1.7 cm. Of the 25 cases of incidental bladder lesions, five were suspected to be due to prostate cancer invasion into the bladder. Only two of these five patients underwent biopsy, which confirmed prostate adenocarcinoma in both cases. Of the 20 patients without suspected prostate cancer invasion of the bladder, four had no suspicious lesions on cystoscopy to warrant a biopsy. The remaining 16 patients had bladder lesions seen on cystoscopy and underwent a biopsy and/or TURBT. Three of these patients had benign features on pathology (urachal remnant, amyloidosis and inflammation) and the remaining 13 had stage Ta urothelial carcinoma. Seven of these patients had low-grade Ta tumors and six had high-grade Ta tumors. All patients were treated with standard management of TURBT with or without intravesical BCG. There have been no reported cases of recurrence or progression in any of the patients in our cohort at the median follow-up of 26 months (interquartile range,19-40 months).
mpMRI of the prostate may yield incidental findings, such as small bladder tumors. Awareness of the possibility of incidental bladder lesions is important as 65% of lesions reported in the bladder, not attributable to extension of prostate cancer, proved to be bladder cancer. This may allow for early intervention for asymptomatic patients with undetected bladder cancer prior to disease progression.
在前列腺多参数磁共振成像（mpMRI）时代，偶尔会在影像学上发现偶发发现。我们旨在报告在无症状患者中，在前列腺 mpMRI 上检测到偶发性膀胱癌的经验，这些患者没有刺激性排尿症状或显微镜下或肉眼血尿。
对 2012 年至 2018 年在我们机构进行前列腺 mpMRI 的所有男性患者的前瞻性维护数据库进行回顾性分析。确定发现偶发性膀胱病变的患者，并记录基线人口统计学，影像学和组织病理学数据。所有在 mpMRI 上发现偶发性膀胱病变但与前列腺癌扩散无关的患者，如果在膀胱镜检查中需要，除了进行膀胱镜检查和/或经尿道膀胱肿瘤切除术（TURBT）外，还进行了活检。
在此期间共进行了 3147 次前列腺 mpMRI，发现 25 例（0.8%）偶发性膀胱病变。这些患者没有任何提示性症状，如肉眼或显微镜下血尿，需要进行膀胱病变检查。偶然发现的膀胱病变的最大直径范围从 0.4 厘米到 1.7 厘米。在 25 例偶发性膀胱病变中，有 5 例怀疑是由于前列腺癌侵犯膀胱所致。这 5 例患者中仅有 2 例进行了活检，证实了前列腺腺癌。在 20 例无可疑前列腺癌侵犯膀胱的患者中，有 4 例在膀胱镜检查中无可疑病变，无需进行活检。其余 16 例患者在膀胱镜检查中发现膀胱病变，并进行了活检和/或 TURBT。其中 3 例患者的病理表现为良性（脐尿管残余，淀粉样变性和炎症），其余 13 例患者为 Ta 期尿路上皮癌。其中 7 例患者为低级别 Ta 肿瘤，6 例患者为高级别 Ta 肿瘤。所有患者均接受标准 TURBT 治疗，伴或不伴膀胱内 BCG。在我们的队列中，所有患者的中位随访时间为 26 个月（四分位距，19-40 个月），均未报告复发或进展的病例。
前列腺 mpMRI 可能会发现偶发性发现，例如小的膀胱肿瘤。了解偶发性膀胱病变的可能性很重要，因为在膀胱中报告的 65%的病变，与前列腺癌的扩散无关，被证实为膀胱癌。这可能允许在疾病进展之前，对无症状且未检测到膀胱癌的患者进行早期干预。
