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
Authors:
Vladimír Šámal 1,2; Igor Richter 3; Vít Paldus 1; Tomáš Jirásek 4; Jan Mečl 1
Authors place of work:
Urologické oddělení, Krajská nemocnice Liberec, a. s., Liberec
1; Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové
2; Onkologické oddělení, Krajská nemocnice Liberec, a. s., Liberec
3; Oddělení patologie, Krajská nemocnice Liberec, a. s., Liberec
4
Published in the journal:
Ces Urol 2020; 24(1): 42-50
Category:
Original Articles
Summary
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 theblock 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 process‑ ing 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 tu‑ mor 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:
prostate cancer – Incidental – Bladder cancer – significant
Zdroje
1. Holund, B. Latent prostatic cancer in a consecutive autopsy series. Scand J Urol Nephrol 1980. 14(1): p. 29–35.
2. Autorino RG, Di Lorenzo R, Damiano G, et al. Pathology of the prostate in radical cystectomy specimens: a critical review. Surg Oncol 2009; 18(1): 73–84.
3. Davila HHT, Weber D, Burday S, et al. Total or partial prostate sparing cystectomy for invasive bladder cancer: long‑term implications on erectile function. BJU Int 2007; 100(5): 1026–1029.
4. Jhavar SGC, Fisher A, Jackson SA, et al. Processing of radical prostatectomy specimens for correlation of data from histopathological, molecular biological, and radiological studies: a new whole organ technique. Journal of clinical pathology 2005; 58(5): 504–508.
5. Samaratunga HR, Montironi L, True JI, et al. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling. Mod Pathol 2011; 24(1): 6–15.
6. Freedland SJME, Sutter F, Dorey, Aronson WJ. Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate‑specific antigen. Urology 2003; 61(2): 365–369.
7. Buse ST, Hofner SC, Muller E, et al. Characterization and risk stratification of prostate cancer in patients undergoing radical cystoprostatectomy. Int J Urol 2013; 20(9): 866–871.
8. Pignot GL, Salomon Y, Neuzillet A, et al. Clinicopathological characteristics of incidental prostate cancer discovered from radical cystoprostatectomy specimen: a multicenter French study. Ann Surg Oncol 2014; 21(2): 684–690.
9. Barbisan FR, Mazzucchelli M, Scarpelli A, et al. Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int 2009; 103(8): 1058–1063.
10. Yin MS, Bastacky U, Chandran MJ, Becich, Dhir R. Prevalence of incidental prostate cancer in the general population: a study of healthy organ donors. J Urol 2008; 179(3): 892–895; discussion 895.
11. Mazzucchelli RF, Barbisan M, Scarpelli A, et al. Is incidentally detected prostate cancer in patients undergoing radical cystoprostatectomy clinically significant? Am J Clin Pathol 2009; 131(2): 279–283.
12. Prošvic PP, Morávek, Šimáková E. Incidentální adenokarcinom prostaty u pacientů po radikální cystektomii pro uroteliální karcinom. Ces Urol 2002; 6(1): 37–40.
13. Kudláčková Š, Král M, Grepl M, Študent V. Výskyt karcinomu prostaty u mužů v materiálu po RACE. Ces Urol 2015; 19(Suppl. B): 33–33.
14. Zhu YP, DW Ye XD, Yao SL, et al. Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries. Asian J Androl 2009; 11(1): 104–108.
15. Androulakakis PAHM, Schneider GH, Jacobi, Hohenfellner R. Coincident vesical transitional cell carcinoma and prostatic carcinoma. Clinical features and treatment. Br J Urol 1986; 58(2): 153–156.
16. Pritchett TR, Moreno J, Warner NE, et al. Unsuspected prostatic adenocarcinoma in patients who have undergone radical cystoprostatectomy for transitional cell carcinoma of the bladder. J Urol 1988; 139(6): 1214–1216.
17. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. Jama 1994; 271(5): 368–374.
18. Epstein JI, Pizov G, Walsh PC. Correlation of pathologic findings with progression after radical retro‑ pubic prostatectomy. Cancer 1993; 71(11): 3582–3593.
19. Epstein JI, Carmichael M, Partin AW, Walsh PC. Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of followup. J Urol 1993; 149(6): 1478–1481.
20. Stamey TA, Freiha FS, McNeal JE, et al. Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 1993; 71(3 Suppl): 933–938.
21. Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer 2004; 101(9): 2001–2005.
22. Hekal IA, El‑Tabey NA, Nabeeh MA, et al. Validation of Epstein criteria of insignificant prostate cancer in Middle East patients. Int Urol Nephrol 2010; 42(3): 667–671.
23. Lee MC, Dong F, Stephenson AJ, et al. The Epstein criteria predict for organ‑confined but not insigni‑ ficant disease and a high likelihood of cure at radical prostatectomy. Eur Urol 2010; 58(1): 90–95.
24. Epstein JI, Allsbrook WC, Jr Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29(9): 1228–1242.
25. Epstein JI. An update of the Gleason grading system. J Urol 2010; 183(2): 433–440.
26. Chen ME, Johnston D, Reyes AO, et al. A streamlined three‑dimensional volume estimation method accurately classifies prostate tumors by volume. Am J Surg Pathol 2003; 27(10): 1291–1301.
27. Carvalhal GF, Humphrey PA, Thorson P, et al. Visual estimate of the percentage of carcinoma is an independent predictor of prostate carcinoma recurrence after radical prostatectomy. Cancer 2000; 89(6): 1308–1314.
28. Pan J, Xue W, Sha J, et al. Incidental prostate cancer at the time of cystectomy: the incidence and clinicopathological features in Chinese patients. PLoS One 2014; 9(4): e94490.
29. Desai A, Wu H, Sun, L, et al. Complete embedding and close step‑sectioning of radical prostatectomy specimens both increase detection of extra‑prostatic extension, and correlate with increased disease‑free survival by stage of prostate cancer patients. Prostate Cancer Prostatic Dis 2002; 5(3): 212–218.
30. Fritsche HM, Aziz A, Eder F, et al. Potentially clinically relevant prostate cancer is found more frequently after complete than after partial histopathological processing of radical cystoprostatectomy specimens. Virchows Arch 2012; 461(6): 655–661.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2020 Číslo 1
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