Background: Incidental prostate cancer refers to clinically unsuspected prostate malignancy detected after surgical treatment for presumed benign prostatic disease. This study aimed to determine the proportion of incidentally detected prostate cancer among symptomatic patients undergoing prostate surgery and to describe its pathological characteristics in a multicenter cohort from Burundi. PatientsandMethods: We conducted a retrospective observational multicenter observational study from January 1 to December 31, 2024, including consecutive patients who underwent prostate surgery in five major hospitals in Bujumbura, Burundi. Patients with a preoperative histopathological diagnosis of prostate cancer were excluded. All surgical specimens were examined histologically, and prostatic adenocarcinoma grading was performed according to the International Society of Urological Pathology (ISUP) grading system. Results: A total of 156 patients were included, with a mean age of 69.00 years. Lower urinary tract symptoms were the most common clinical presentation, occurring in 138 patients (88.46%). Digital rectal examination was normal in 86 patients (55.13%), while a palpable prostatic nodule was identified in 41 patients (26.28%). Transurethral resection of the prostate was the most frequently performed procedure (38.46%). Incidental prostate cancer was identified in 76 patients (48.72%; 95% confidence interval [CI]: 40.90%-56.60%), all corresponding to prostatic adenocarcinoma. Among these patients, high-grade tumors were predominant, with ISUP grade 5 observed in 43 cases (56.58%). Benign prostatic hyperplasia was diagnosed in 55 patients (35.26%), whereas squamous cell carcinoma was identified in 25 patients (16.03%), including primary prostatic and secondary bladder-related cases. Conclusion: Incidental prostate cancer was frequently detected among patients undergoing prostate surgery in Bujumbura. The predominance of high-grade tumors highlights the importance of systematic histopathological evaluation of all prostate surgical specimens, particularly in resource-limited settings where access to advanced diagnostic tools remains limited.
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