Incidence, Clinicopathological Features, and Survival Impact of Incidental Prostate Cancer in Radical...

To evaluate the incidence, clinicopathological characteristics, and impact on overall survival (OS) of incidental prostate cancer (iPCa) detected in patients undergoing radical cystoprostatectomy (RCP) for bladder cancer.

We retrospectively analyzed data from 395 male patients who underwent RCP for urothelial carcinoma between January 2009 and January 2022. Patients with a preoperative diagnosis of prostate cancer were excluded. iPCa was classified as clinically significant (csPCa) based on Gleason score ≥7, stage ≥pT3a, or positive surgical margins. Survival outcomes were evaluated using Kaplan-Meier methods and Multivariable Cox regression analysis to identify independent predictors of mortality.

Incidental prostate cancer was detected in 136 patients (34.4%). Patients with iPCa were significantly older than those without (median 66 vs. 63 years, p=0.026). The majority of tumors were organ-confined (96.3%) and clinically insignificant (80.1%). Apical tumor involvement was observed in 19.1% of cases. In univariate analysis, the presence of iPCa was associated with worse OS (median 965 vs. 1821 days, p=0.008). However, in multivariable analysis adjusting for age and tumor characteristics, iPCa was not an independent predictor of survival (HR: 1.295, p=0.077). The primary independent risk factors for mortality were advanced age, lymph node positivity, and muscle-invasive bladder cancer.

Incidental prostate cancer is a frequent finding during radical cystoprostatectomy but is predominantly clinically insignificant and does not independently compromise overall survival. The observed survival difference in univariate analysis is primarily driven by advanced patient age rather than the prostatic malignancy itself. Management should remain conservative for low-risk cases. However, the detection of apical involvement in nearly 20% of cases warrants caution regarding prostate-sparing cystectomy techniques.