Survival in Synchronous Versus Metachronous Bladder & Prostate Cancer

Survival in Synchronous Versus Metachronous Bladder & Prostate Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Survival in Synchronous Versus Metachronous Bladder & Prostate Cancer Berrin Yalcin, Ebru Tuncay, Serdar Arslan, Hilmi Enes Araci, Hikmet Köseoğlu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7579205/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose We aimed to evaluate co-occurrence of prostate and bladder cancer. As well, we sought for their clinicopathological characteristics, and oncological outcomes according to the status of being either synchronous or metachronous during the oncological follow-up. Methods Retrospective data query set to timeline of 2011-2023 from hospital database resulted in a total of 72 patients with synchronous or metachronous prostate and bladder cancer. Patients with synchronous cancers were assigned as group I. The patients having metachronous bladder cancer after prostate cancer were assigned as group II and group III included patients with metachronous prostate cancer after bladder cancer. Results Group I (synchronous) included 33 (46%) patients, metachronous tumors in total included 39 (54%) patients (29 patients (40%) in group II and 10 patients (14%) in group III). Rate of high-grade bladder cancer (72%) and presence of CIS (47%) were higher in synchronous tumors. Five and ten-year overall survival and metastasis free survival rates were lower in synchronous group compared to metachronous groups. The 10-year survival rates for all three groups were 61%, 89% and 91%, respectively. Lungs were the most common metastatic site in all groups, and the third most common cancer was lung cancer. Conclusions The survival rate in synchronous groups is lower. In addition, the risk of a third tumor is high in patients with synchronous or metachronous tumors. The occurrence of lung cancer as the third most common tumor in these patients might be related to the common habit of smoking. Biological sciences/Cancer Health sciences/Oncology Health sciences/Urology Prostate Bladder Cancer Survival Co-occurrence Synchronous Metachronous Figures Figure 1 Figure 2 INTRODUCTION According to the recent Global Cancer statistics, prostate cancer holds in 4 th place with an incidence of 7.3% frequency and bladder cancer is in 9th place with an incidence of 3.1% among all cancer sites [1]. Men with prostate cancer (Pca) have been reported to have an increased risk of developing bladder cancer (Bca). The sharing of the same pathogenesis pathways in the development of Pca and Bca have been suggested to be the reason for the association of these cancers [2]. Moreover, some risk factors, including genetic background, hormonal factors, smoking, immune deficiency etc. may be associated with the coexistence of prostate and bladder cancer [3,4]. Advanced age is also a common risk factor for both cancers. In addition, this increase in incidence of any of the relevant cancer types might be due to cumulative effect of radiation dosage exposed due to staging and follow up imaging studies of either of them. Accumulating evidence has shown that patients with primary Bca undergoing radical cystoprostatectomy have higher rate of incidental prostatic tumors [5,6]. Some studies considered that these incidental Pca might not affect severely the survival of patients [7,8]. These studies underline that prostate cancers detected incidentally after radical cystectomy tend to be low grade, therefore, low-risk prostate cancers [5,7,8]. In contrast, some other recent studies emphasize that incidental Pca may also be more aggressive and lower overall survival rates in Bca patients with concurrent Pca [9,10]. Therefore, in this investigation, we sought clinicopathological features and oncological results of synchronous metachronous prostate and bladder cancer with follow-up. PATIENTS and METHODS In the study, we defined “ synchronous cancers ” when both cancers were diagnosed simultaneously or within 6 months regardless of the order. “Metachronous cancers” was defined both cancers were diagnosed in time period beyond six months regardless of the order. Inclusion criteria in the study were as follows: (1) histologically proven adenocarcinoma of prostate and urothelial bladder cancer; (2) patient diagnosed over the age of 18; (3) patient without metastatic disease at initial diagnosis; (4) patients with documented treatment parameters and follow-up information. After approval of the study by the local ethics committee, retrospective data query set to timeline from January 2011 to December 2023 resulted in a total of 72 patients with synchronous or metachronous prostate and bladder cancer from patient database of our university-based hospital. All 72 patients underwent biopsy or radical surgery (prostatectomy or cystoprostatectomy) and were confirmed pathologically to have prostate cancer and bladder cancer The patients’ demographics and clinical data were noted from the database. While all related laboratory and pathology results were obtained from hospital database, data related to treatment follow-up were obtained from clinical files and by phone when necessary. All patients underwent abdominopelvic computed tomography (CT) and/or magnetic resonance imaging (MRI). Prostate cancer patients underwent prostate-specific membrane antigen positron emission tomography (PSMA-PET/CT) to exclude distant metastasis. The primary endpoint of the study was the clinical pathological characteristics of patients with metachronous /synchronous bladder and prostate cancer. The patients were divided into 3 groups. Patients with synchronous cancers were assigned as group I. The patients who developed metachronous bladder cancer after prostate cancer were assigned as group II and group III included patients developed with metachronous prostate cancer after bladder cancer. Secondary endpoints were survival times. Metastasis-free survival (MFS), overall survival (OS) and 3rd cancer development time (3rdCDT) were examined in each patient group. MFS, OS and 3rdCDT were defined as the time from diagnosis till metastasis, death and time period which a de novo cancer develops, respectively. Follow-up has been performed every 6 months for 2 years to 5 years, and once a year after 5 years. During the follow-up period PSMA-PET and MRI examinations were requested in patients with suspected local or regional recurrence , distant metastasis and patients with suspected new cancer. After imaging, biopsies had been taken from the patients for definitive histopathological diagnosis. Statistical analyses were performed with SPSS statistics software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Comparisons of clinical and pathological parameters among groups were tested with Pearson Chi square test, Mann-Whitney U test or Kruskal-Wallis test where appropriate. Mean, standard deviation, and median values were used while presenting descriptive analyzes. The mean values were presented with standard deviation or range. Kaplan-Meier curves were used to show time-to-event outcomes over time in terms of overall survival (OS) and metastasis-free survival (MFS). All statistical tests were performed by 2-sided tests. A P value of 0.05 was considered to demonstrate a statistically significant difference. RESULTS In the study, which included a total of 72 patients with both Pca and Bca. While synchronous group had 33 (46%) patients, metachronous group had 39 (54%) patients (group II had 29 (40%) and group III had 10 (14%) patients). Some baseline parameters of patients clinicopathological features and oncological results are given in Table 1. The presence of comorbidities and the risk of developing metachronous tumors (18 (62%) in group II and 7(70%) in group III, p=0.008). The comorbidity, especially hypertension, between the groups (16 (55%) in group II and 5 (50%) in group III) differed significantly (p = 0.015). Rate of high grade TCC (72%) and CIS (47%) (carcinoma in-situ) were higher in the synchronous tumors than in the groups II and III (p=0.033, and p=0.007, respectively). When bladder cancer T staging was compared, pTa and pT1 were found to be higher in both synchronous and metachronous groups, while ≥pT2 were found to be higher in patients in the synchronous group (p = 0.016). The rates of early stage TCC (< pT2) were 61%, 100% and 60% in group I, group II and group III respectively. All patients in group II interestingly had early stage TCC, and this difference was statistically significant (p=0.001). Table I. Demographics and the clinicopathological features of the patients Synchronous Metachronous P value 46% (33) 54%(39) Group I Group II Group III 46% (33) 40% (29) 14% (10) Diagnostic GAP Mean ± S.D. (Mean) 0.94±1.46 (0) 73.86±46.18 (48.00) 29.60±23.50 (22.86) Age (Mean) 71.70±7.71 74.41±5.95 75.00±9.44 Age (Median) 72.00 74.00 75.50 Age Groups (70 years) > 70 years 19(58%) 21(72%) 6(60%) 0.461 ≤ 70 years 14(42%) 8(28%) 4(40%) Smoker Yes 24 (73%) 16(55%) 6(60%) 0.348 No 9(27%) 13(45%) 4(40%) Smoke pack*year/day 37.13±19.56 38.25±7.59 56.67±32.60 0.700 Family History Yes 5(15%) 4(14%) 0(0%) 0.431 No 28(85%) 25(86%) 10(100%) Comorbidity Yes 10(30%) 18(62%) 7(70%) 0.015 No 23(70%) 11(38%) 3(30%) Hypertension Yes 6(18%) 16(55%) 5(50%) 0.008 No 27(85%) 13(45%) 5(50%) Diabetes Mellitus Yes 5(15%) 8(28%) 2(20%) 0.484 No 28(85%) 21(72%) 8(80%) Others Yes 6(18%) 4(14%) 2(20%) 0.858 No 27(82%) 25(86%) 8(80%) Pathology TCC 32(97%) 29(100%) 8(80%) 0.056 Adenocarcinoma 1(3%) 0(0%) 1(10%) Other 0(0%) 0(0%) 1(10%) Bladder Tumor Grade High Grade 23(72%) 14(50%) 2(25%) 0.033 Low Grade 9(28%) 14(50%) 9(75%) CIS Presence Yes 15(47%) 5(8%) 0(0%) 0.007 No 17(53%) 23(82%) 8(100%) T Staging (Bladder) 0.001 <pT2 20(61%) 28(100%) 6(60.0%) ≥pT2 13(39%) 0(0%) 4(40.0%) Prostate Cancer Diagnostic Mode of Surgery TRUS-biopsy 10(30.3%) 23(79.3%) 5(50.0%) <0.001 TUR-P 3(9.1%) 5(17.2%) 1(10.0%) Cystoprostatectomy 20(60.6%) 1(3.4%) 4(40.0%) T Staging (Prostate) pT1a 20(60.6%) 2(6.9%) 0(0%) 0.001 pT1b 10(30.3%) 3(10.3%) 1(10.0%) pT1c 2(6.1%) 23(79.3%) 5(50.0%) pT2 1(3%) 1(3.4%) 4(40.0%) ISUP Stage 0.561 I 25(75.8%) 21(50.0%) 5(72.4%) II 5(15.2%) 4(20.0%) 2(13.8%) III 1(3.0%) 2(10.0%) 1(6.9%) IV 2(6.1%) 0(0%) 1(6.9%) V 0(0%) 2(10.0%) 1(6.9%) Metastasis Presence Yes 11(33%) 2(7%) 3(30%) 0.036 No 22(67%) 27(93%) 7(70%) Metastasis Time (months) 18.27±42.30 0.07±378 7.30±13.614 Metastasis site Bone 4(15%) 2(7%) 3(100%) 0.183 Lung 3(21%) 0(0%) 0(0%) 0.010 Other Site 4(18%) 0(0%) 10% 0.055 Number of Metastatic Site One Site 6(54.5%) 2(100%) 2(66.7%) 0.468 ≥Two Site 5(45.5%) 0(0%) 1(33.3%) Tertiary Tm 9% (3) 10% (3) 10% (1) Lung Cancer 2 3 1 Larynx Cancer 1 - - Follow-up Period (months) 74.21±40.69 99.30±37.01 144.45±53.72 Exitus 8 (24%) 5 (17%) 1 (10%) 0.569 Alive 25(76%) 24(83%) 9(90%) Synchronous tumors were diagnosed by cystoprostatectomy (60.6%, group I), while metachronous tumors were diagnosed by biopsy (79.3% and 50%, group I and group II, respectively, p=0.001). Prostate cancer T staging compared the pT1a (60.6%) and pT1b (30.3%) was high in synchronous tumors, but pT1c (79.3% in group I and 3.4% in group II) and pT2 (50 % in group I and 40% in group II) tumor was high metachronous tumors (p=0.001). Synchronous tumors were found to metastasize more frequently than metachronous tumors (33%), which was statistically significant (p=0.036) In addition, while lung metastasis (21%) was frequently seen in synchronous tumors (p=0.010). Lung cancer was found to be the third most common cancer among both synchronous and metachronous cancers. Patient follow-up time was 74 months (range 29-217), 99 months (range 42-144) and 144 months (range 41-252) in group I, group II and group III respectively. Eight patients (24%) from group I, 5 patients (17%) from group II and 1 patient (10%) from group III died during follow up. The Kaplan−Meier curves, OS and MFS were evaluated three groups (Figure:1A-1B). Statistical differences were found when OS and MFS values were evaluated in both groups (p=0.035 and p=0.015). It was shown that OS and MFS time was shorter in synchronous group compared to metachronous groups (group II and group III) patients. Median OS was 147 months for group I, 133 months for group II, and 220 months for group III. The 5-year OS rates for all 3 groups were 81.9%, 89% and 96%, the 10-year survival rates for all three groups were 61%, 89% and 91%, respectively. Median MFS was 107 months for group I, 96 months for group II, and 216 months for group III. The 5-year MFS rates for all 3 groups were 73%, 70% and 92%, the 10-year survival rates for all three groups were 47%, 70% and 92%, respectively. Additionally, we compared OS and MFS of patients in the synchronous and metachronous groups (Figure:2A-2B). OS and MFS were found to be statistically significant in the comparison of two groups (for synchronous tumors p=0.010 and for metachronous tumors p=0.012). The 5-year OS and MFS rates for synchronous tumors and metachronous tumors were 76%, 94.6% and 73%, 87%, the 10-year OS rate for synchronous tumors and metachronous tumors were 61%, 90.5% and 47%, 87%, respectively. DISCUSSION In this study, we systematically analyzed the clinical, pathological, and treatment outcomes in patients with metachronous and synchronous Pca-Bca. Compared to metachronous tumors, we found that synchronous tumors demonstrated some clinical features related to worse oncology outcomes, such as high-grade, advanced stage, and worse OS and MFS survival. We detected a higher rate of lung cancer as the tertiary tumor as well as higher rates of metastasis to lung in the synchronous tumor group. Our findings might help us to be more careful in the follow-up and treatment selection. Many studies have also shown that patients with synchronous and metachronous tumors tended to be older patients [11,12]. Likewise, in our study, we found that the median patient age was 70 years. It has been observed that the risk of cancer increases with the presence of additional diseases and increasing age. A significant relationship was found between the presence of comorbidities and the risk of developing metachronous tumors (18 (62%) of group 2 and 7(70%) group 3, p=0.015). It was found to be higher especially in the patient group with hypertension and metachronous tumors (16 (55%) of group 2 and 5(50%) group 3, p=0.008). This suggests that older patients may have more co-morbidities and therefore may be related to drug use. Some studies in literature have suggested a relationship between aggressive bladder cancer pathology and concurrent malignancies [13,14]. Likewise in this study we determined that in synchronous Pca-Bca cases, higher grade bladder cancer rate, higher CIS and ≥pT2 were present (p=0.033, p=0.007 and p=0.001, respectively), confirming worser oncology outcomes in synchronous tumors. In the literature, incidental prostate cancer has been reported to be 17-70% of radical cystoprostatectomy specimens [15-19]. The rate of diagnosis with cystoprostatectomy and the rate of incidental prostate cancer were found to be high in the synchronous group (p <0.001) in our study, as statistically significant and consistent with literature. Mortality is higher in patients who undergo cystoprostatectomy due to advanced bladder cancer rather than prostate cancer stage in synchronous tumors [20]. The high rate of cystectomy in patients with synchronous tumors, as we have emphasized before, and the fact that bladder cancer in these patients is at an advanced T stage and has aggressive pathologies, supports this idea in our study. Multiple primary tumors have been linked to increased malignant behavior and worse prognoses compared to a single primary tumor [21]. In addition, synchronous multiple primary tumors have been correlated with the decreased survival rate [22]. Longer median survival time in the metachronous group was suggested to be related to the fact that the first malignancy was diagnosed and treated at an earlier time, allowing a longer lag time before the development of the second primary malignancy. When survival times between synchronous and metachronous groups were compared in our study, we found that metachronous patients had a longer overall survival and metastasis free survival. The OS and MFS rates were higher as statistically significant for both 5-year and 10-year follow up periods. In separate comparisons between Group II metachronous and synchronous, and between Group III metachronous and synchronous, groups II and III both had statistically significant higher 5-year and 10-year survival rates for both OS and MFS. The lower survival rate in synchronous tumors was related to the advanced stage of bladder cancer at diagnosis, higher post radical cystectomy mortality rates and failure in treating both tumors at the same time efficiently [23]. These facts were also confirmed by our study. The cause and development mechanism of multiple primary tumors have not yet been fully elucidated. However, intensive application of diagnostic methods and follow-up policies resulted detection of both synchronous and metachronous tumors. On the other hand, patient specific genetic background and behavioral risk factors such as smoking seem to play a role in the development of secondary cancers. Similarly, in our study, since the most common metastatic site in synchronous and metachronous tumors was the lung and the third most common cancer was lung cancer, we thought that it might be related to smoking. Therefore, we do emphasize the critical importance of smoking cessation in patients with multiple tumors. The limitations of our study are as follows; First, this is a single center study. Also, this study included unique population at risk of multiple primary cancers, which in this case is the tendency of a higher rate of tobacco use in the Turkish population. The second significant limitation was the heterogenous nature of treatments received by these cancer patients. In instance, radiotherapy and chemotherapy might have a causative effect for secondary cancers by distorting DNA molecules. Thirdly, group III include only 10 patients, which limits the accuracy. CONCLUSION Multiple primary tumors are not rarely encountered in cancer patients. Early diagnosis of multiple primary tumors and multidisciplinary approaches to sequencing their treatment may further prolong survival in these cases. According to the results of the study and the most recent data were analyzed and we compared synchronous / metachronous Pca and Bca patients found lower OS and MFS survival results in synchronous Pca and Bca. Our data reveals the risk of a third tumor is high in patients with synchronous or metachronous tumors. We suggest that the reason for this lung cancer may be related to smoking. Declarations Funding The authors declare that there is no funding support for this study. Ethics declarations Conflict of interests The authors declare no competing interests. Ethical approval This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the local Ethics Committee and the institutional review board of University of Health Sciences, Istanbul Training and Research Hospital, Istanbul Turkey (Institutional Review Board No. 16; 27.01.2023). in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Informed consent was obtained from all participants or their relatives in case of death involved in this study. Consent for publication The publication has been approved by all co-authors. ACKNOWLEDGEMENTS The study was presented as a poster in the 43 rd Congress of SIU, October 11-14, 2023, Istanbul. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 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J Urol 179:S27–32 Sivalingam S, Drachenberg D (2013) The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre. Can Urol Assoc J 7:35–38 Dembowski J, Hackemer P, Winkler A, Otlewska A, Tupikowski K, Zdrojowy R (2015) Prostate and Bladder Cancer Coexistence in Patients Undergoing Radical Cystoprostatectomy. Adv Clin Exp Med 24:657–662 Lee J, Park S, Kim S, Kim J, Ryu J, Park HS, Kim SI, Park BW (2015) Characteristics and Survival of Breast Cancer Patients with Multiple Synchronous or Metachronous Primary Cancers. Yonsei Med J 56:1213–1220 Powell S, Tarchand G, Rector T, Klein M (2013) Synchronous and metachronous malignancies: analysis of the Minneapolis Veterans Affairs (VA) tumor registry. Cancer Causes Control 24:1565–1573 Dembowski J, Hackemer P, Winkler A, Otlewska A, Tupikowski K, Zdrojowy R (2015) Prostate and Bladder Cancer Coexistence in Patients Undergoing Radical Cystoprostatectomy. Adv Clin Exp Med 24:657–662 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7579205","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":513512019,"identity":"9064aa0b-b4ef-42f5-82a2-35738934774b","order_by":0,"name":"Berrin Yalcin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACAwYGxgNAsn7/8R6wAA8fEVoYQFoYG86cAbEYeNiI0wK0quFGDoRFUIu5RPKDAz8K7jAzznx78PHHHDsZNgbmh49u4NFiOSPN4GCPwTM2Zum8ZIOD25KBDmMzNs7B57AbCQaHGQwO87BJ55hJHNzGDNQCYuPVkv4BpEWCR/IMSEs9MVpywLYYSEjwgLQcJqzFsudNAdAvhxMMeHKMDc5uO87DxkzAL+bs6Rsf/PgD1MJ+xvBB5bZqe3725oeP8WlhEEhAF2HGpxwE+A8QUjEKRsEoGAUjHgAAjINK3XqV8xUAAAAASUVORK5CYII=","orcid":"","institution":"University of Health Sciences, Istanbul Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Berrin","middleName":"","lastName":"Yalcin","suffix":""},{"id":513512020,"identity":"f0390ab6-8e42-410e-a6d3-b4fd68b54a9f","order_by":1,"name":"Ebru Tuncay","email":"","orcid":"","institution":"University of Health Sciences, Istanbul Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ebru","middleName":"","lastName":"Tuncay","suffix":""},{"id":513512021,"identity":"7ed53856-9e5f-4d45-a479-47f5c54a5a50","order_by":2,"name":"Serdar Arslan","email":"","orcid":"","institution":"University of Health Sciences, Istanbul Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Serdar","middleName":"","lastName":"Arslan","suffix":""},{"id":513512022,"identity":"c92d443b-0a21-43e5-a417-6de802998066","order_by":3,"name":"Hilmi Enes Araci","email":"","orcid":"","institution":"University of Health Sciences, Istanbul Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hilmi","middleName":"Enes","lastName":"Araci","suffix":""},{"id":513512023,"identity":"57553cef-834e-4685-8709-610ad66ca40d","order_by":4,"name":"Hikmet Köseoğlu","email":"","orcid":"","institution":"University of Health Sciences, Istanbul Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hikmet","middleName":"","lastName":"Köseoğlu","suffix":""}],"badges":[],"createdAt":"2025-09-10 06:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7579205/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7579205/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91512960,"identity":"7145575c-2bb3-4610-8e7f-04a97acdb1a6","added_by":"auto","created_at":"2025-09-17 08:54:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":317304,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Curve for Overall Survival for all 3 groups (1A) Kaplan-Meier Curve for Metastasis-Free Survival for all 3 groups (1B)\u003c/p\u003e","description":"","filename":"Figure01.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7579205/v1/f2c0685bf5e27149569f4014.jpg"},{"id":91512959,"identity":"e2b5723f-50e5-4fa8-abe9-5f79bc50e677","added_by":"auto","created_at":"2025-09-17 08:54:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":337215,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Curve for Overall Survival in synchronous and metachronous groups (2A) Kaplan-Meier Curve for Metastasis-Free Survival in synchronous and metachronous groups (2B)\u003c/p\u003e","description":"","filename":"Figure02.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7579205/v1/84dffd14dcf23fa4566c760e.jpg"},{"id":91513500,"identity":"af10abe6-cf03-410b-b070-9def580387c2","added_by":"auto","created_at":"2025-09-17 09:02:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1534907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7579205/v1/b9713805-0dcb-45ae-964d-1624536fd705.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSurvival in Synchronous Versus Metachronous Bladder \u0026amp; Prostate Cancer\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAccording to the recent Global Cancer statistics, prostate cancer holds in 4\u003csup\u003eth\u0026nbsp;\u003c/sup\u003eplace with an incidence of 7.3% frequency and bladder cancer is in 9th place with an incidence of 3.1% among all cancer sites [1]. Men with prostate cancer (Pca) have been reported to have an increased risk of developing bladder cancer (Bca). The sharing of the same pathogenesis pathways in the development of Pca and Bca have been suggested to be the reason for the association of these cancers [2].\u0026nbsp;Moreover, some risk factors, including genetic background, hormonal factors, smoking, immune deficiency etc. may be associated with the coexistence of prostate and bladder cancer [3,4]. Advanced age is also a common risk factor for both cancers. In addition, this increase in incidence of any of the relevant cancer types might be due to cumulative effect of radiation dosage exposed due to staging and follow up imaging studies \u0026nbsp; of either of them.\u003c/p\u003e\n\u003cp\u003eAccumulating evidence has shown that patients with primary Bca undergoing radical cystoprostatectomy have higher rate of incidental prostatic tumors [5,6]. Some studies considered that these incidental Pca might not affect severely the survival of patients [7,8]. These studies underline that prostate cancers detected incidentally after radical cystectomy tend to be low grade, therefore, low-risk prostate cancers [5,7,8].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn contrast, some other recent studies emphasize that incidental Pca may also be more aggressive and lower overall survival rates in Bca patients with concurrent Pca [9,10].\u003c/p\u003e\n\u003cp\u003eTherefore, in this investigation, we sought clinicopathological features and oncological results of synchronous metachronous prostate and bladder cancer with follow-up.\u003c/p\u003e"},{"header":"PATIENTS and METHODS","content":"\u003cp\u003eIn the study, we defined \u0026ldquo;\u003cem\u003esynchronous cancers\u003c/em\u003e\u0026rdquo; when both cancers were diagnosed simultaneously or within 6 months regardless of the order. \u003cem\u003e\u0026ldquo;Metachronous cancers\u0026rdquo; was\u0026nbsp;\u003c/em\u003edefined\u003cem\u003e\u0026nbsp;\u003c/em\u003eboth cancers were diagnosed in time period beyond six months regardless of the order. Inclusion criteria in the study were as follows: (1) histologically proven adenocarcinoma of prostate and urothelial bladder cancer; (2) patient diagnosed over the age of 18; (3) patient without metastatic disease at initial diagnosis; (4) patients with documented treatment parameters and follow-up information.\u003c/p\u003e\n\u003cp\u003eAfter approval of the study by the local ethics committee, retrospective data query set to timeline from January 2011 to December 2023 resulted in a total of 72 patients with synchronous or metachronous prostate and bladder cancer from patient database of our university-based hospital. All 72 patients underwent biopsy or radical surgery (prostatectomy or cystoprostatectomy) and were confirmed pathologically to have prostate cancer and bladder cancer The patients\u0026rsquo; demographics and clinical data were noted from the database. While all related laboratory and pathology results were obtained from hospital database, data related to treatment follow-up were obtained from clinical files and by phone when necessary. All patients underwent abdominopelvic computed tomography (CT) and/or magnetic resonance imaging (MRI). Prostate cancer patients underwent prostate-specific membrane antigen positron emission tomography (PSMA-PET/CT) to exclude distant metastasis.\u003c/p\u003e\n\u003cp\u003eThe primary endpoint of the study was the clinical pathological characteristics of patients with metachronous /synchronous bladder and prostate cancer. The patients were divided into 3 groups. Patients with synchronous cancers were assigned\u0026nbsp;as group I. The patients who developed metachronous bladder cancer after prostate cancer were assigned\u0026nbsp;as group II and group III included patients developed with metachronous prostate cancer after bladder cancer. \u0026nbsp;Secondary endpoints were survival times. Metastasis-free survival (MFS), overall survival (OS) and 3rd cancer development time (3rdCDT) were examined in each patient group. MFS, OS and 3rdCDT were defined as the time from diagnosis till metastasis, death and time period which a de novo cancer develops, respectively. Follow-up has been performed every 6 months for 2 years to 5 years, and once a year after 5 years. \u0026nbsp;During the follow-up period PSMA-PET and MRI examinations were requested in patients with suspected local or regional recurrence\u003cstrong\u003e,\u003c/strong\u003e distant metastasis and patients with suspected new cancer. After imaging, biopsies had been taken from the patients for definitive histopathological diagnosis.\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed with SPSS statistics software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Comparisons of clinical and pathological parameters among groups were tested with Pearson Chi square test, Mann-Whitney U test or Kruskal-Wallis test where appropriate. Mean, standard deviation, and median values were used while presenting descriptive analyzes. The mean values were presented with standard deviation or range. Kaplan-Meier curves were used to show time-to-event outcomes over time in terms of overall survival (OS) and metastasis-free survival (MFS). All statistical tests were performed by 2-sided tests. A \u003cem\u003eP\u003c/em\u003e value of 0.05 was considered to demonstrate a statistically significant difference.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn the study, which included a total of 72 patients with both Pca and Bca. While synchronous group had 33 (46%) patients, metachronous group had 39 (54%) patients (group II had 29 (40%) and group III had 10 (14%) patients). Some baseline parameters of patients clinicopathological features and oncological results are given in Table 1. The presence of comorbidities and the risk of developing metachronous tumors (18 (62%) in group II and 7(70%) in group III, p=0.008). \u0026nbsp;The comorbidity, especially hypertension, between the groups (16 (55%) in group II and 5 (50%) in group III) differed significantly (p = 0.015). Rate of high grade TCC (72%) and CIS (47%) (carcinoma in-situ) were higher in the synchronous tumors than in the groups II and III (p=0.033, and p=0.007, respectively). When bladder cancer T staging was compared, pTa and pT1 were found to be higher in both synchronous and metachronous groups, while \u0026ge;pT2 were found to be higher in patients in the synchronous group (p = 0.016). The rates of early stage TCC (\u0026lt; pT2) were 61%, 100% and 60% in group I, group II and group III respectively. All patients in group II interestingly had early stage TCC, and this difference was statistically significant (p=0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable I.\u0026nbsp;\u003c/strong\u003eDemographics and the clinicopathological features of the patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSynchronous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetachronous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e46% (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 268px;\"\u003e\n \u003cp\u003e54%(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup I\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e46% (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e40% (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e14% (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnostic GAP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; S.D. (Mean)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.94\u0026plusmn;1.46 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e73.86\u0026plusmn;46.18 (48.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e29.60\u0026plusmn;23.50 (22.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Mean)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e71.70\u0026plusmn;7.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e74.41\u0026plusmn;5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e75.00\u0026plusmn;9.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Median)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e72.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e74.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e75.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Groups (70 years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026gt; 70 years\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e19(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e21(72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026le; 70 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;years\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e14(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoker \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e24 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e16(55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e9(27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13(45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoke pack*year/day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e37.13\u0026plusmn;19.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e38.25\u0026plusmn;7.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e56.67\u0026plusmn;32.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e28(85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25(86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e10(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e18(62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e23(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e11(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e6(18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e16(55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e27(85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13(45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eDiabetes Mellitus\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e28(85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e21(72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e6(18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e27(82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25(86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eTCC\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e32(97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e29(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAdenocarcinoma\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1(3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBladder Tumor Grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eHigh Grade\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e23(72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e14(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLow Grade\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e9(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e14(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9(75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCIS Presence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e15(47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e17(53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e23(82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT Staging (Bladder)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026lt;pT2\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e20(61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e28(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6(60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026ge;pT2\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13(39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProstate Cancer Diagnostic Mode of Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eTRUS-biopsy\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e10(30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e23(79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eTUR-P\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e3(9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eCystoprostatectomy\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e20(60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT Staging (Prostate)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003epT1a\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e20(60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003epT1b\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e10(30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e3(10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003epT1c\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e23(79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003epT2\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1(3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISUP Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25(75.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e21(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003eIV\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cul type=\"circle\"\u003e\n \u003cli\u003e\u003cstrong\u003eV\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetastasis Presence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e11(33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e22(67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e27(93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetastasis Time (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e18.27\u0026plusmn;42.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.07\u0026plusmn;378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7.30\u0026plusmn;13.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetastasis site\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eBone\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4(15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLung\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e3(21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eOther Site\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4(18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Metastatic Site\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eOne Site\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e6(54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026ge;Two Site\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5(45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTertiary Tm\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e9% (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e10% (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10% (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLung Cancer\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLarynx Cancer\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up Period (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e74.21\u0026plusmn;40.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e99.30\u0026plusmn;37.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e144.45\u0026plusmn;53.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25(76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e24(83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9(90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSynchronous tumors were diagnosed by cystoprostatectomy (60.6%, group I), while metachronous tumors were diagnosed by biopsy (79.3% and 50%, group I and group II, respectively, p=0.001). Prostate cancer T staging compared the pT1a (60.6%) and pT1b (30.3%) was high in synchronous tumors, but pT1c (79.3% in group I and 3.4% in group II) and pT2 (50 % in group I and 40% in group II) tumor was high metachronous tumors (p=0.001). Synchronous tumors were found to metastasize more frequently than metachronous tumors (33%), which was statistically significant (p=0.036) In addition, while lung metastasis (21%) was frequently seen in synchronous tumors (p=0.010). Lung cancer was found to be the third most common cancer among both synchronous and metachronous cancers.\u003c/p\u003e\n\u003cp\u003ePatient follow-up time was 74 months (range 29-217), 99 months (range 42-144) and 144 months (range 41-252) in group I, group II and group III respectively. Eight patients (24%) from group I, 5 patients (17%) from group II and 1 patient (10%) from group III died during follow up.\u003c/p\u003e\n\u003cp\u003eThe Kaplan\u0026minus;Meier curves, OS and MFS were evaluated three groups (Figure:1A-1B). \u0026nbsp;Statistical differences were found when OS and MFS values were evaluated in both groups (p=0.035 and p=0.015). It was shown that OS and MFS time was shorter in synchronous group compared to metachronous groups (group II and group III) patients. Median OS was 147 months for group I, 133 months for group II, and 220 months for group III. The 5-year OS rates for all 3 groups were 81.9%, 89% and 96%, the 10-year survival rates for all three groups were 61%, 89% and 91%, respectively. Median MFS was 107 months for group I, 96 months for group II, and 216 months for group III. The 5-year MFS rates for all 3 groups were 73%, 70% and 92%, the 10-year survival rates for all three groups were 47%, 70% and 92%, respectively.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Additionally, we compared OS and MFS of patients in the synchronous and metachronous groups (Figure:2A-2B). OS and MFS were found to be statistically significant in the comparison of two groups (for synchronous tumors p=0.010 and for metachronous tumors p=0.012). The 5-year OS and MFS rates for synchronous tumors and metachronous tumors were 76%, 94.6% and 73%, 87%, the 10-year OS rate for synchronous tumors and metachronous tumors were 61%, 90.5% and 47%, 87%, respectively.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we systematically analyzed the clinical, pathological, and treatment outcomes in patients with metachronous and synchronous Pca-Bca. Compared to metachronous tumors, we found that synchronous tumors demonstrated some clinical features related to worse oncology outcomes, such as high-grade, advanced stage, and worse OS and MFS survival. We detected a higher rate of lung cancer as the tertiary tumor as well as higher rates of metastasis to lung in the synchronous tumor group. Our findings might help us to be more careful in the follow-up and treatment selection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany studies have also shown that patients with synchronous and metachronous tumors tended to be older patients [11,12]. \u003csup\u003e\u0026nbsp;\u003c/sup\u003eLikewise, in our study, we found that the median patient age was 70 years. It has been observed that the risk of cancer increases with the presence of additional diseases and increasing age. A significant relationship was found between the presence of comorbidities and the risk of developing metachronous tumors (18 (62%) of group 2 and 7(70%) group 3, p=0.015). It was found to be higher especially in the patient group with hypertension and metachronous tumors (16 (55%) of group 2 and 5(50%) group 3, p=0.008). This suggests that older patients may have more co-morbidities and therefore may be related to drug use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome studies in literature have suggested a relationship between aggressive bladder cancer pathology and concurrent malignancies [13,14].\u003csup\u003e\u0026nbsp;\u003c/sup\u003e Likewise in this study we determined that in synchronous Pca-Bca cases, higher grade bladder cancer rate, higher CIS and \u0026ge;pT2 were present (p=0.033, p=0.007 and p=0.001, respectively), confirming worser oncology outcomes in synchronous tumors.\u003c/p\u003e\n\u003cp\u003eIn the literature, incidental prostate cancer has been reported to be 17-70% of radical cystoprostatectomy specimens [15-19].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe rate of diagnosis with cystoprostatectomy and the rate of incidental prostate cancer were found to be high in the synchronous group (p \u0026lt;0.001) in our study, as statistically significant and consistent with literature. Mortality is higher in patients who undergo cystoprostatectomy due to advanced bladder cancer rather than prostate cancer stage in synchronous tumors [20].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe high rate of cystectomy in patients with synchronous tumors, as we have emphasized before, and the fact that bladder cancer in these patients is at an advanced T stage and has aggressive pathologies, supports this idea in our study.\u003c/p\u003e\n\u003cp\u003eMultiple primary tumors have been linked to increased malignant behavior and worse prognoses compared to a single primary tumor [21]. In addition, synchronous multiple primary tumors have been correlated with the decreased survival rate [22]. Longer median survival time in the metachronous group was suggested to be related to the fact that the first malignancy was diagnosed and treated at an earlier time, allowing a longer lag time before the development of the second primary malignancy.\u0026nbsp;When survival times between synchronous and metachronous groups were compared in our study, we found that metachronous patients had a longer overall survival and metastasis free survival. The OS and MFS rates were higher as statistically significant for both 5-year and 10-year follow up periods. In separate comparisons between Group II metachronous and synchronous, and between Group III metachronous and synchronous, groups II and III both had statistically significant higher 5-year and 10-year survival rates for both OS and MFS. The lower survival rate in synchronous tumors was related to the advanced stage of bladder cancer at diagnosis, higher post radical cystectomy mortality rates and failure in treating both tumors at the same time efficiently [23]. These facts were also confirmed by our study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe cause and development mechanism of multiple primary tumors have not yet been fully elucidated. However, intensive application of diagnostic methods and follow-up policies resulted detection of both synchronous and metachronous tumors. On the other hand, patient specific genetic background and behavioral risk factors such as smoking seem to play a role in the development of secondary cancers. Similarly, in our study, since the most common metastatic site in synchronous and metachronous tumors was the lung and the third most common cancer was lung cancer, we thought that it might be related to smoking. Therefore, we do emphasize the critical importance of smoking cessation in patients with multiple tumors.\u003c/p\u003e\n\u003cp\u003eThe limitations of our study are as follows; First, this is a single center study. Also, this study included unique population at risk of multiple primary cancers, which in this case is the tendency of a higher rate of tobacco use in the Turkish population. The second significant limitation was the heterogenous nature of treatments received by these cancer patients. In instance, radiotherapy and chemotherapy might have a causative effect for secondary cancers by distorting DNA molecules. Thirdly, group III include only 10 patients, which limits the accuracy.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eMultiple primary tumors are not rarely encountered in cancer patients. Early diagnosis of multiple primary tumors and multidisciplinary approaches to sequencing their treatment may further prolong survival in these cases.\u003c/p\u003e\n\u003cp\u003eAccording to the results of the study and the most recent data were analyzed and we compared synchronous / metachronous Pca and Bca patients found lower OS and MFS survival results in synchronous Pca and Bca. Our data reveals the risk of a third tumor is high in patients with synchronous or metachronous tumors. We suggest that the reason for this lung cancer may be related to smoking.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no funding support for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the local Ethics Committee and the institutional review board of University of Health Sciences, Istanbul Training and Research Hospital, Istanbul Turkey (Institutional Review Board No. 16; 27.01.2023).\u0026nbsp;in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Informed consent was obtained from all participants or their relatives in case of death involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe publication has been approved by all co-authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was presented as a poster in the 43\u003csup\u003erd\u003c/sup\u003e Congress of SIU, October 11-14, 2023, Istanbul.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024)\u0026nbsp;Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 74:229\u0026ndash;263\u003c/li\u003e\n \u003cli\u003eSingh A, Jones RF, Friedman H, Hathir S, Soos G, Zabo A, Haas GP (1999) Expression of p53 and pRb in bladder and prostate cancers of patients having both cancers. Anticancer Res 19:5415\u0026ndash;5417\u003c/li\u003e\n \u003cli\u003eAbdeen Y, Al-Amer M, Taft E, Al-Halawani M (2021) Four synchronous primary tumors in a male patient. J Cancer Res Ther 17:258\u0026ndash;261\u003c/li\u003e\n \u003cli\u003eJing Y, Zhang R, Ma P, Cai MC, Zhuang G, Chen H (2018) Prevalence and clonality of synchronous primary carcinomas in the bladder and prostate. J Pathol 244:5\u0026ndash;10\u003c/li\u003e\n \u003cli\u003eWu S, Lin SX, Lu M, Subtelny AO, Wang Z, Dahl DM, Olumi AF, Wu CL (2019) Assessment of 5-year overall survival in bladder cancer patients with incidental prostate cancer identified at radical cystoprostatectomy. Int Urol Nephrol 51:1527\u0026ndash;1535\u003c/li\u003e\n \u003cli\u003eMalte R, Kluth LA, Kaushik D, et al (2017) Frequency and prognostic significance of incidental prostate cancer at radical cystectomy: Results from an international retrospective study. Eur J Surg Oncol 43:2193\u0026ndash;2199\u003c/li\u003e\n \u003cli\u003ePackiam VT, Tsivian M, Avulova S, et al (2020) Long-term outcomes of incidental prostate cancer at radical cystectomy. Urol Oncol 38:848.e17-848.e22\u003c/li\u003e\n \u003cli\u003eDamiano R, Di Lorenzo G, Cantiello F, De Sio M, Perdon\u0026agrave; S, D\u0026apos;Armiento M, Autorino R (2007) Clinicopathologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence-based analysis. Eur Urol 52:648\u0026ndash;657\u003c/li\u003e\n \u003cli\u003eAbdelhady M, Abusamra A, Pautler SE, Chin JL, Izawa JI (2007) Clinically significant prostate cancer found incidentally in radical cystoprostatectomy specimens. BJU Int 99:326\u0026ndash;329\u003c/li\u003e\n \u003cli\u003eBruins HM, Djaladat H, Ahmadi H, Sherrod A, Cai J, Miranda G, Skinner EC, Daneshmand S (2013) Incidental prostate cancer in patients with bladder urothelial carcinoma: comprehensive analysis of 1,476 radical cystoprostatectomy specimens. J Urol 190:1704\u0026ndash;1709\u003c/li\u003e\n \u003cli\u003eChung HS, Seo YH, Jung SI,\u0026nbsp;Hwang EC, Kang TW, Kwonet DD (2017)\u0026nbsp;Comparison of synchronous and metachronous primary carcinomas of the bladder and prostate.\u0026nbsp;Korean J Urol Oncol 15:44\u0026ndash;50. https://doi.org/10.22465/kjuo.2017.15.1.44\u003c/li\u003e\n \u003cli\u003eHoshi S, Bilim V, Hoshi K, et al (2024) Double Primary Cancer of the Prostate and Urothelial Cancer: A Single Institution Experience. J Pers Med 14:510\u003c/li\u003e\n \u003cli\u003eQarro A, Ammani A, Bazine K, Najoui M, Samir J, Alami M (2014) Synchronous primary malignancies of the male urogenital tract. Can Urol Assoc J 8:E353\u0026ndash;E355\u003c/li\u003e\n \u003cli\u003eMontironi R, Mazzucchelli R, Santinelli A, Scarpelli M, Beltran AL, Bostwick DG (2005) Incidentally detected prostate cancer in cystoprostatectomies: pathological and morphometric comparison with clinically detected cancer in totally embedded specimens. Hum Pathol 36:646\u0026ndash;654\u003c/li\u003e\n \u003cli\u003eBarbisan F, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Kirkali Z, Montironi R (2009) Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int 103:1058\u0026ndash;1063\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStein JP, Lieskovsky G, Cote R, et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666\u0026ndash;675\u003c/li\u003e\n \u003cli\u003eVallancien G, Abou El Fettouh H, Cathelineau X, Baumert H, Fromont G, Guillonneau B (2002) Cystectomy with prostate sparing for bladder cancer in 100 patients: 10-year experience. J Urol 168:2413\u0026ndash;2417\u003c/li\u003e\n \u003cli\u003eRevelo MP, Cookson MS, Chang SS, Shook MF, Smith JA Jr, Shappell SB (2008) Incidence and location of prostate and urothelial carcinoma in prostates from cystoprostatectomies: implications for possible apical sparing surgery. J Urol 179:S27\u0026ndash;32\u003c/li\u003e\n \u003cli\u003eSivalingam S, Drachenberg D (2013) The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre. Can Urol Assoc J 7:35\u0026ndash;38\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDembowski J, Hackemer P, Winkler A, Otlewska A, Tupikowski K, Zdrojowy R (2015) Prostate and Bladder Cancer Coexistence in Patients Undergoing Radical Cystoprostatectomy. Adv Clin Exp Med 24:657\u0026ndash;662\u003c/li\u003e\n \u003cli\u003eLee J, Park S, Kim S, Kim J, Ryu J, Park HS, Kim SI, Park BW (2015) Characteristics and Survival of Breast Cancer Patients with Multiple Synchronous or Metachronous Primary Cancers. Yonsei Med J 56:1213\u0026ndash;1220\u003c/li\u003e\n \u003cli\u003ePowell S, Tarchand G, Rector T, Klein M (2013) Synchronous and metachronous malignancies: analysis of the Minneapolis Veterans Affairs (VA) tumor registry. Cancer Causes Control 24:1565\u0026ndash;1573\u003c/li\u003e\n \u003cli\u003eDembowski J, Hackemer P, Winkler A, Otlewska A, Tupikowski K, Zdrojowy R (2015) Prostate and Bladder Cancer Coexistence in Patients Undergoing Radical Cystoprostatectomy. Adv Clin Exp Med 24:657\u0026ndash;662\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prostate, Bladder, Cancer, Survival, Co-occurrence, Synchronous, Metachronous ","lastPublishedDoi":"10.21203/rs.3.rs-7579205/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7579205/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e We aimed to evaluate co-occurrence of prostate and bladder cancer. As well, we sought for their clinicopathological characteristics, and oncological outcomes according to the status of being either synchronous or metachronous during the oncological follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Retrospective data query set to timeline of 2011-2023 from hospital database resulted in a total of 72 patients with synchronous or metachronous prostate and bladder cancer. Patients with synchronous cancers were assigned as group I. The patients having metachronous bladder cancer after prostate cancer were assigned as group II and group III included patients with metachronous prostate cancer after bladder cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Group I (synchronous) included 33 (46%) patients, metachronous tumors in total included 39 (54%) patients (29 patients (40%) in group II and 10 patients (14%) in group III). Rate of high-grade bladder cancer (72%) and presence of CIS (47%) were higher in synchronous tumors. Five and ten-year overall survival and metastasis free survival rates were lower in synchronous group compared to metachronous groups. The 10-year survival rates for all three groups were 61%, 89% and 91%, respectively. Lungs were the most common metastatic site in all groups, and the third most common cancer was lung cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e The survival rate in synchronous groups is lower. In addition, the risk of a third tumor is high in patients with synchronous or metachronous tumors. The occurrence of lung cancer as the third most common tumor in these patients might be related to the common habit of smoking.\u003c/p\u003e","manuscriptTitle":"Survival in Synchronous Versus Metachronous Bladder \u0026amp; Prostate Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 08:54:32","doi":"10.21203/rs.3.rs-7579205/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03a53615-5aa4-41b3-be3f-aba19d5b0ee9","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54775286,"name":"Biological sciences/Cancer"},{"id":54775287,"name":"Health sciences/Oncology"},{"id":54775288,"name":"Health sciences/Urology"}],"tags":[],"updatedAt":"2025-09-17T08:54:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 08:54:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7579205","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7579205","identity":"rs-7579205","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}