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Sir,

We read with interest this article by Abdelhady et al. [1]; we performed a similar retrospective study comprising 100 consecutive patients (mean age 65.4 years) who had a radical cystoprostatectomy in our unit, with a mean follow-up of 6 years. Unlike Abdelhady et al. we monitored biochemical rather than clinical recurrence; we found that the incidence of incidental prostate cancer detected after radical cystoprostatectomy was 26%, similar to the 28% reported by Abdelhady et al. We note that 22% of their patients had clinically significant disease at surgery; this high value might be due to the variables used to differentiate between clinically significant and clinically insignificant disease. Significant disease covered a broad spectrum, including Gleason grade ≥4, total tumour volume ≥0.5 mL, through to extracapsular extension and lymph node metastasis. We differentiated between localised and non-localised disease, as one would when treating prostate cancer. This would appear to be a simplified way of categorising patients. We found the incidence of localised, incidental prostate cancer in our group was 24%; the remaining 2% had extracapsular extension. Patients with localised disease were followed for a mean (range) of 5.5 (1–9) years; only one developed biochemical recurrence (PSA level 0.4 ng/mL) at 78 months. No patients received additional treatment and they remained under surveillance. Patients with extracapsular extension were referred to the prostate cancer multidisciplinary team meeting, and treated appropriately. We agree that the argument for radical removal of the prostate with the bladder is substantiated not only because transitional cells reside in the prostate, but also patients with TCC of the bladder considering prostate-sparing surgery must be aware that they are at greater risk of developing prostate cancer. Our study showed that there is no significant biochemical failure rate in patients found to have incidental, low-grade, localised prostate cancer at radical cystoprostatectomy. The PSA level after surgery is of value in these patients, and annual surveillance with a PSA assay is sufficient. There appeared to be no effect on 5-year survival in our patients.