Did you know that a LOT of prostate cancer (PCa) is never actually detected while the person was living? Here are some interesting numbers:

• In men who died of other causes, 21% of autopsies reveal PCa across all ages
• Over half of men aged 90 or above who die of other causes are found to have PCa upon autopsy

Why were these cancers not found? Well, in most cases it’s because they were indolent (“lazy”) or insignificant (not likely to progress to more aggressive disease). But since a large number of PCa tumors aren’t even found during life, how do we know whether a tumor in a living man’s prostate gland is insignificant?

The obvious answer is, we don’t. However, sometimes PCa is discovered during surgery for something else. This is the case with certain bladder cancers that must be surgically removed. The procedure to remove the entire bladder is called a cystectomy and when the prostate is removed as well, it’s called a cystoprostatectomy. Since the latter surgery removes the prostate as well as the bladder, the prostate specimen is examined. This is when PCa will be detected, and it’s called an incidental finding. Voila! There’s a PCa tumor the patient never even knew he had.

How often is PCa an incidental finding of bladder removal? And how many incidental findings were of life-threatening PCa? Numbers vary according to studies:

• In a study of 193 men who had cystoprostatectomy, 31 (16.1%) had PCa. All were Grade Group 1 (insignificant)^[i].
• In another study of 237 men who had cystoprostatectomy, 43 (18.1%) had PCa. While most had insignificant PCa, those who were older and had higher PSA before surgery were more likely to be found with significant PCa.^[ii]
• In a third study of 64 patients, 11 (17.2%) had PCa, and of those 8 (72.7%) were clinically insignificant.^[iii]

To sum up, in all cases fewer than 20% of patients had incidental PCa findings, and the majority were insignificant. Generally, incidental PCa findings that are clinically insignificant have no impact on survival. A word of caution: had the prostate glands containing insignificant disease been left in place, it’s not possible to predict whether a certain percentage might have progressed in aggressiveness. Interestingly, however, one study found that in men who had bladder removal surgery for bladder cancer, those who had incidental PCa findings actually had BETTER overall 5-year survival than men without incidental findings (58% vs. 53%).^[iv] Although we don’t have an explanation for this particular outcome, we can safely say that even if PCa is not detected in your lifetime, you are more likely to die WITH prostate cancer than FROM it.

One final word: it’s better to detect than not detect PCa when it’s at an early stage. Once detected, a multiparametric MRI (mpMRI) can characterize it with high accuracy. Is it dangerous, or isn’t it? If it isn’t, a patient and doctor can discuss minimally invasive focal treatments, Active Surveillance, or other management strategies. If it appears dangerous, on the other hand, an in-bore MRI-guided targeted biopsy can provide the most accurate diagnosis with minimal needles—and an appropriate treatment plan can be made.

The risk in failing to detect PCa early is that there’s a small chance it may become a killer. So, remember: have an annual PSA test and, if it’s suspicious, get an mpMRI scan to determine whether or not a biopsy is necessary. The prostate you save may be your own.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] https://www.renalandurologynews.com/home/conference-highlights/eau-congress/prostate-cancer-found-at radical-cystectomy-usually-clinically-insignificant/?
[ii] Tanaka T, Koie T, Ohyama C, Hashimoto Y et al. Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy. Jpn J Clin Oncol. 2017 Nov 1;47(11):1078-1082.
[iii] Dell’Atti L. Relevance of prostate cancer in patients with synchronous invasive bladder urothelial carcinoma: a monocentric retrospective analysis. Arch Ital Urol Androl. 2015 Mar 31;87(1):76-9.
[iv] https://advances.massgeneral.org/urology/journal.aspx?id=1510