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The incidence of and mortality rate from prostate cancer have been rising rapidly in Taiwan in recent years. Prostate specimens obtained during cystoprostatectomy may play a role in the study of prostate cancer evolution. Methods: From January 2001 to December 2005, we collected and examined retrospectively 65 prostate specimens obtained from patients during cystoprostatectomy performed for various conditions. Fourteen patients (21%) had evidence of prostate cancer and 11 (17%) had high-grade prostatic intraepithelial neoplasia. Results: We compared our results with those of a previous study conducted at the same institute from 1992 to 1997. There was no statistical difference between the two groups in unsuspected prostate cancer prevalence (p = 0.263), but the prevalence declined from 32.7% to 21.5%. Conclusion: The results imply that the epidemiological decline in unsuspected prostate cancer in central Taiwan may be associated with the wide application of testing for prostatic specific antigen.