Unsuspected adenocarcinoma of the prostate in patients undergoing cystoprostatectomy for other causes: incidence, histology and morphometric observations.

Cystoprostatectomy specimens were evaluated in 66 male patients operated on for a pathological condition of the bladder with no evidence of prostatic malignancy on preoperative clinical assessment. There were 38 prostate cancers identified in 25 of 66 patients (38 per cent). Multiple foci of adenocarcinoma were noted in 10 of 25 patients (40 per cent). The mean tumor volume was 0.11 cc, with half of the cancers being less than or equal to 0.01 cc in volume. All 38 cancers were completely localized to the prostate and exact anatomical sites of origin for each of the cancers within the prostate were mapped. Whereas anatomical distribution of the cancers in the anteroposterior dimension was roughly uniform, a distinct predominance of apical prostatic cancers was observed. Possible anatomical explanations and implications of these findings in terms of the apical surgical margins at radical prostatectomy and cystoprostatectomy, and the new technologies currently available for diagnosis of prostate cancer are discussed.