Incidental bladder cancer detected by routine cystoscopy before robot-assisted radical prostatectomy: A multicenter retrospective study.

INTRODUCTION: To evaluate the role of routine cystoscopy before robot-assisted radical prostatectomy (RARP) in detecting incidental bladder cancer (BC) and to identify clinical factors associated with BC detection. METHODS: In this retrospective study conducted at 2 institutions, we included 918 patients who underwent routine cystoscopy before RARP between August 2014 and March 2025. We assessed incidental BC detection, detection of intermediate- or high-risk nonmuscle-invasive BC (NMIBC), and cystoscopy-related events, including urinary tract infection (UTI) and changes in planned prostate cancer (CaP) treatment. RESULTS: Incidental BC was detected in 18 of 918 patients (1.96%), including 8 cases of intermediate- or high-risk NMIBC. Increasing age was significantly associated with BC detection (odds ratio [OR] per 1-year increase, 1.13; 95% confidence interval [CI], 1.02-1.25). Patients aged ≥70 years had a higher BC detection rate (3.2%; OR, 3.96; 95% CI, 1.29-12.1). Nine patients switched to alternative CaP treatments, including radiotherapy and/or androgen deprivation therapy. Among the 9 patients who underwent RARP after bladder tumor resection, the median interval from cystoscopy to RARP was 10.8 months, with no clinically evident CaP progression before RARP. During a median follow-up of 34.6 months, no BC recurrence or dissemination-suggestive recurrence was identified. UTI occurred in 6 patients (0.7%). CONCLUSION: Routine cystoscopy before RARP identified previously unrecognized BC, including clinically significant lesions. Older age was associated with BC detection; however, this finding should be regarded as hypothesis-generating. Further prospective studies are needed to determine whether age-based or risk-adapted cystoscopy strategies are appropriate before RARP.