Bladder involvement can lead to prostate cancer misdiagnosis

By Stephanie Leveene, medwireNews Reporter

Men with lesions in the neck, trigone, or posterior wall of the bladder should be tested for basal prostate cancer as well as bladder cancer to ensure that they are not misdiagnosed, say researchers.

The team, led by Yong Xu (Second Hospital of Tianjin Medical University, China), found that serum prostate-specific antigen (PSA) measurements and digital rectal examination (DRE), in combination with transrectal ultrasound, magnetic resonance imaging (MRI), and prostate needle biopsy, were valuable for accurately differentiating basal prostate cancer from bladder cancer in these cases.

The researchers reviewed all 455 patients with prostate cancer treated at their institutions between April 2003 and June 2011 and analyzed the tests they underwent. Fourteen were initially misdiagnosed as having bladder cancer.

Abdominal color ultrasounds of the urinary system revealed that these patients all had hypoechoic regions in the bladder neck and trigone, and were therefore clinically considered to have bladder-occupying lesions. This was also suggested by routine computed tomography (CT) scans carried out in nine of the patients, with evidence of intra-bladder, irregular soft tissue shadows.

However, the patients all showed signs of elevated PSA levels, ranging from 10 ng/mL to over 100 ng/mL, and DRE sleep quality, nocturia, dreams/nightmares, restless legs symptoms, and sleep-disordered breathing results revealed a hard prostate in nine patients and second- to fourth-degree prostate enlargement in 10 patients.

MRI, carried out in 11 of the 14 patients, proved more effective than CT, and showed in most cases that the bladder-protruding lesions were in fact connected to lesions in the prostate; this led to a correct diagnosis of prostate cancer in four of the patients and prostate cancer invading into the bladder in seven patients.

Prostate cancer was also confirmed with the use of prostate needle biopsy in 12 of the 14 patients and by transurethral resection of the prostate in the remaining two, with Gleason scores ranging from 7 to 9.

Xu and colleagues note that the symptomatic clinical manifestations the patients had are “similar to those of bladder neck tumor infiltrating into deep muscular layer. Therefore, this can lead into a misdiagnosis of bladder cancer instead of prostate cancer.”

They recommend that clinicians faced with such unclear cases look for prostates with disorganized structures and/or enlarged basal regions protruding into the bladder.

“A multi-view analysis can clinically reduce the rate of [prostate cancer] misdiagnosis,” the researchers conclude, adding: “[Prostate] biopsy should also be performed when prostate cancer is suspected.”

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