Aim: To investigate the rates of prostate cancer (Pca) in radical cystoprostatectomy (RCP) specimens for bladder cancer in mainland China. To determine the follow-up outcome of patients with two concurrent cancers and identify whether prostate-specific antigen (PSA) is a useful tool for the detection of Pca prior to surgery. Methods: From January 2002 to January 2007, 264 male patients with bladder cancer underwent RCP at our center. All patients underwent digital rectal examination (DRE) and B ultrasound. Serum PSA levels were tested in 168 patients. None of the patients had any evidence of Pca before RCP. Entire prostates were embedded and sectioned at 5 mm intervals. Results: Incidental Pca was observed in 37 of 264 (14.0%) RCP specimens. Of these, 12 (32.4%) were clinically significant according to an accepted definition. The PSA levels were not significantly different between patients with Pca and those without Pca, nor between patients with significant Pca and those with insignificant Pca. Thirty-four patients with incidental Pca were followed up. During a mean follow-up period of 26 months, two patients with PSA > 4 ng/mL underwent castration. None of the patients died of Pca. Conclusion: The incidence of Pca in RCP specimens in mainland China is lower than that in most developed countries. PSA cannot identify asymptomatic Pca prior to RCP. In line with published reports, incidental Pca does not impact the prognosis of bladder cancer patients undergoing RCP.