Cancer‐specific survival and predictors of prostate‐specific antigen recurrence and survival in patients with seminal vesicle invasion after radical prostatectomy

Abstract

BACKGROUNDThe objectives of the current study were to determine the long‐term biochemical recurrence (BCR) and cancer‐specific survival (CSS) rates for men with seminal vesicle invasion (SVI) and to identify risk factors for freedom from BCR and CSS in patients who received treatment in the prostate‐specific antigen era and who had SVI identified at the time of radical prostatectomy (RP).METHODSProspective clinical, pathologic, and outcome data were collected for 5377 men who underwent RP between June 1983 and August 2004. There were 936 patients who were excluded because they received treatment before RP. Multivariable analysis was used to identify the factors that predicted BCR and CSS.RESULTSAmong 4441 eligible patients, 387 patients (8.7%) had SVI, and 91 of those 387 patients (24%) had lymph node involvement (LNI). In total, 210 patients experienced BCR. For patients without LNI, the 10‐year and 15‐year freedom from BCR rates were 36% and 32%, respectively, and the corresponding CSS rates were 89% and 81%, respectively. For the 91 men who had SVI and LNI, the 10‐year BCR‐free probability was 10%, but the 10‐year CSS probability was 74%. By 10 years, patients with LNI were 3 times more likely to die from cancer than from other causes; nonetheless, 66% of patients were alive despite their advanced stage. The preoperative prostate‐specific antigen level, extracapsular extension, LNI, and Gleason grade were associated independently with BCR. Gleason scores of 8 to 10 and LNI were significant predictors of CSS.CONCLUSIONSSVI does not invariably signal BCR or death from cancer in patients who undergo RP and pelvic lymph node dissection. Fifteen years later, approximately 33% of men with SVI and negative lymph nodes are expected remain free of BCR, and CSS was surprisingly good. Cancer 2006. © 2006 American Cancer Society.

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

“…Secin et al reported the probabilities of 10-year BCRFS in pT3bN1 and pT3bN0 patients to be 10% and 36%, respectively. 6 In the current study, the difference between 5-year BCRFS rates for lymph node metastasis and no lymph node metastasis was significant (0% and 18.2%, respectively, P < 0.001).…”

“…Secin et al reported that a positive surgical margin was not an independent predictor of BCRFS in patients with SVI after radical prostatectomy, regardless of lymph node status. 6 In the current study, positive surgical margin was an independent predictor of BCRFS only in men with pT3bN0 tumors (HR 2.29, 95% CI 1.12-4.71, P = 0.024).…”

“…3 The incidence of this in men with pT3b tumors is reported to be 61-76% in the literature. [4][5][6]9 In the current study that included only extraprostatic SVI cases, extracapsular extension coexisted in 81.7% of the men with SVI.…”

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

“…While the rate of SVI (pT3bN0) has more than halved from 7.%7 to 3.6%, SVI remains a strong predictor of biochemical recurrence and cancer specific mortality. 7,16 …”

“…7 A second analysis of 220 men similarly demonstrated a high rate of recurrence (54%) and no benefit to adjuvant or salvage therapy. 3 Using a larger, comprehensive database from our institution, we investigated outcomes in men with pT3b disease treated predominantly without ART in the contemporary era.…”