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Characterization and risk stratification of prostate cancer in patients undergoing radical cystoprostatectomy
Author(s) -
Buse Stephan,
Höfner Thomas,
Müller Stephan C,
Hermann Edwin,
Wieland Wolf F,
May Matthias,
Stief Christian G,
Bastian Patrick J,
Hohenfellner Markus,
Haferkamp Axel
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12073
Subject(s) - medicine , prostate cancer , cystoprostatectomy , bladder cancer , prostate , odds ratio , urology , concomitant , malignancy , cancer , prostatectomy , hazard ratio , confidence interval , cancer registry , oncology , gynecology
Objective 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. Methods 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 C ox regression, and the association between age and the occurrence of prostate cancer was calculated by logistic regression. Results 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. Conclusions 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.