A Contemporary Analysis of Outcomes of Adenocarcinoma of the Prostate With Seminal Vesicle Invasion (pT3b) After Radical Prostatectomy

Abstract

Purpose Despite earlier detection and stage migration, seminal vesicle invasion is still reported in the prostate specific antigen era and remains a poor prognostic indicator. We investigated outcomes in men with pT3b disease in the contemporary era. Materials and Methods The institutional radical prostatectomy database (1982 to 2010) of 18,505 men was queried and 989 with pT3b tumors were identified. The cohort was split into pre-prostate specific antigen (1982 to 1992), and early (1993 to 2000) and contemporary (2001 to present) prostate specific antigen eras. Of the 732 men identified in the prostate specific antigen era 140 had lymph node involvement and were excluded from study. The Kaplan-Meier method was used to determine biochemical recurrence-free, metastasis-free and prostate cancer specific survival. Proportional hazard models were used to determine predictors of biochemical recurrence-free, metastasis-free and cancer specific survival. Results In the pre-prostate specific antigen, and early and contemporary prostate specific antigen eras, 7.7%, 4.3% and 3.3% of patients, respectively, had pT3bN0 disease (p >0.001). In pT3bN0 cases, the 10-year biochemical recurrence-free survival rate was 25.8%, 28.6% and 19.6% (p = 0.8), and the cancer specific survival rate was 79.9%, 79.6% and 83.8% (p = 0.6) among the eras, respectively. In pT3bN0 cases in the prostate specific antigen era, prostate specific antigen, clinical stage T2b or greater, pathological Gleason sum 7 and 8–10, and positive surgical margins were significant predictors of biochemical recurrence-free survival on multivariate analysis while clinical stage T2c or greater and Gleason 8–10 were predictors of metastasis-free and cancer specific survival. Conclusions Despite a decreased frequency of pT3b disease, and lower rates of positive surgical margins and lymph nodes, patients with seminal vesicle invasion continue to have low biochemical recurrence-free survival. Advanced clinical stage, intermediate or high risk Gleason sum at pathological evaluation and positive surgical margins predict biochemical recurrence. High risk clinical stage and Gleason sum predict metastasis-free and cancer specific survival.

Evaluation of prognostic factors after radical prostatectomy in pT3b prostate cancer patients in Japanese population

“…Despite the high rate of BCR in patients with pT3b disease, cancerspecific survival was excellent in our small series, and this favorable outcome was also confirmed by other previous reports (4)(5)(6)(7)(8). Although post-operative management has not been clearly defined for pT3b cases (5,10,11), multimodal treatments including radiation to the prostatic bed or hormonal therapy will allow the patients to survive for many years even after PCa growth beyond the gland.…”

“…Considering prognostic factors for BCR of pT3b patients, Gleason score of surgically removed whole-mount sections, surgical margin status, pre-operative PSA and clinical stage have been considered as independent predictors (4,5,7,8). In this investigation, we only selected four variables considering our small sample size.…”

Does bilateral seminal vesicle invasion at radical prostatectomy predict worse prognosis than unilateral invasion among patients with pT3b prostate cancers?

“…[18][19][20] While the incidence of SVI has decreased of late, the survival rate of men with SVI has not changed significantly. 1 Eggener et al reported that the respective 4-and 7-year cancer-specific survival rates were 95% and 80% in men with SVI in the pre-PSA era compared with 99% and 93%, in the PSA era (P = 0.02). 2 However, a recent large study failed to show any improvement in survival.…”

Seminal Vesicle Invasion: Accuracy and Analysis of Infiltration Patterns with High-Spatial Resolution T2-Weighted Sequences on Endorectal Magnetic Resonance Imaging

“…The most common variables are Gleason score, clinical T-stage and presence of positive surgical margins [1,13,14,15,33]. MRI provides detailed anatomical information that can be used for surgical planning or application of radiotherapy or further risk stratification [34].…”

“…Invasion of the seminal vesicles (SVI) in patients with prostate cancer (PCa) is reported after radical prostatectomy in 3.3-7.7% of the cases [1]. Those patients with pT3b disease exhibit a poorer prognosis due to increased treatment failure and tumor recurrence [2].…”