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

Lee, Hyun Jung; Han, Junhee; Lee, Dong Hoon; Nam, Jong Kil; Kim, Tae Nam; Chung, Moon Kee; Park, Sung Woo

doi:10.1111/iju.13144

Cited by 14 publications

(26 citation statements)

References 28 publications

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“…The aforementioned adverse features are often considered an indication for adjuvant radiotherapy. For example, 80-86% of patients with seminal vesicle invasion suffer from PSA recurrence [18,19]. Hence, we excluded these patients.…”

Section: Discussionmentioning

confidence: 99%

Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy Versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension

et al. 2019

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Background: It remains unclear whether patients with positive surgical margins or extracapsular extension benefit from adjuvant radiotherapy following radical prostatectomy. Objective: To compare the effectiveness and tolerability of adjuvant radiotherapy following radical prostatectomy. Design, setting, and participants: This was a randomised, open-label, parallel-group trial. A total of 250 patients were enrolled between April 2004 and October 2012 in eight Finnish hospitals, with pT2 with positive margins or pT3a, pN0, M0 cancer without seminal vesicle invasion. Intervention: A total of 126 patients received adjuvant radiotherapy at 66.6 Gy. Outcome measurements and statistical analysis: The primary endpoint was biochemical recurrence-free survival, which we analysed using the Kaplan-Meier method and Cox proportional hazard regression. Overall survival, cancer-specific survival, local recurrence, and adverse events were secondary endpoints. Results and limitations: The median follow-up time for patients who were alive when the follow-up ended was 9.3 yr in the adjuvant group and 8.6 yr in the observation group. The 10-yr survival for biochemical recurrence was 82% in the adjuvant group and

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Section: Discussionmentioning

confidence: 99%

Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy Versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension

et al. 2019

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“…The incidence of lymph node involvement in T3b PCa is particularly high, ranging from 12% to 38% in surgical series [8–13,37–41] and 26% in our series (on MRI). In surgical studies, the lymph node involvement is the most significant prognostic factor of biochemical recurrence (HR = 2.1), DFS (HR = 2.9), and cause-specific survival (HR = 2.4) [9,14]. The lymph node involvement was also identified in our study as the only significant prognostic factor in multivariate analysis on biochemical recurrence (HR = 2.9), clinical recurrence (HR = 2.9), and PCa death (HR = 4.4).…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiotherapy for prostate cancer with seminal vesicle involvement (T3b): A multicentric retrospective analysis

et al. 2019

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ObjectivesNo study has reported clinical results of external-beam radiotherapy specifically for T3b prostate cancer. The possibility of escalating the dose to the involved seminal vesicles (ISV) while respecting the dose constraints in the organs at risk is thus so far not clearly demonstrated. The objective of the study was to analyze the dose distribution and the clinical outcome in a large series of patients who received IMRT for T3b prostate cancer.Materials and methodsThis retrospective analysis included all patients who received IMRT and androgen deprivation therapy for T3b prostate cancer, between 2008 and 2017, in six French institutions, with available MRI images and dosimetric data.ResultsA total of 276 T3b patients were included. The median follow-up was 26 months. The median (range) prescribed doses (Gy) to the prostate and to the ISV were 77 (70–80) and 76 (46–80), respectively. The dose constraint recommendations were exceeded in less than 12% of patients for the rectum and the bladder. The 5-year risks of biochemical and clinical recurrences and cancer-specific death were 24.8%, 21.7%, and 10.3%, respectively. The 5-year risks of local, pelvic lymph node, and metastatic recurrences were 6.4%, 11.3%, and 15%, respectively. The number of involved lymph nodes (≤ 2 or ≥ 3) on MRI was the only significant prognostic factor in clinical recurrence (HR 9.86) and death (HR 2.78). Grade ≥ 2 acute and 5-year late toxicity rates were 13.2% and 12% for digestive toxicity, and 34% and 31.5% for urinary toxicity, respectively. The dose to the pelvic lymph node and the age were predictive of late digestive toxicity.ConclusionIMRT for T3b prostate cancer allows delivery of a curative dose in the ISV, with a moderate digestive toxicity but a higher urinary toxicity. Lymph node involvement increases the risk of recurrence and death.

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“…SVI in PCa affects both patient prognosis and surgical strategy . In older series, SVI is reported to be as high as 26%; more recent series report SVI ranging from 5 to 9% …”

Section: Introductionmentioning

confidence: 99%

“…SVI in PCa affects both patient prognosis and surgical strategy. [1][2][3][4][5] In older series, SVI is reported to be as high as 26%; 6 more recent series report SVI ranging from 5 to 9%. 7,8 There are four ways in which SVI can occur: type I, or per continuitatem extension, where SVI occurs from extension up the wall of the ejaculatory duct; type IIa, or per contiguitatem extension, where SVI occurs as a continuation of extracapsular extension at the base; type IIb, where SVI occurs after extracapsular extension and periprostatic involvement, then ab extrinseco seminal vesicle invasion; and type III, where discrete metastasis to the seminal vesicles occurs.…”

Section: Introductionmentioning

confidence: 99%

Novel nomogram for the prediction of seminal vesicle invasion including multiparametric magnetic resonance imaging

et al. 2019

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Objectives To create a model that predicts side‐specific seminal vesicle invasion using clinical, biopsy and multiparametric magnetic resonance imaging data. Methods We analyzed data from 544 patients who underwent robot‐assisted radical prostatectomy at a single institution. To develop a side‐specific predictive model, we ultimately considered four variables: prostate‐specific antigen, highest ipsilateral biopsy Gleason grade, highest ipsilateral percentage core involvement and seminal vesicle invasion on multiparametric magnetic resonance imaging. A binary multivariable logistic regression model was fitted to predict seminal vesicle invasion. A nomogram was then built based on the coefficients of the resulting logit function. The leave‐one‐out cross validation method was used for internal validation, and the decision curve analysis for the evaluation of the net clinical benefit. Results We relied on 804 side‐specific cases after excluding negative biopsy observations (n = 284). Seminal vesicle invasion was reported on multiparametric magnetic resonance imaging in 41 (5%) cases, and on final pathology in 64 (8%) cases. All variables in the model emerged as predictors of seminal vesicle invasion (all P ≤ 0.001) and were subsequently considered to build a nomogram. The area under the curve of multiparametric magnetic resonance imaging alone in predicting seminal vesicle invasion was 59.1%; whereas one of the clinical variables only was 85.1%. The area under the curve of the nomogram resulting from their combination was 86.5%. After internal validation, this resulted in 84.7%. The model achieved good calibration and the decision curve analysis showed its clinical benefit, especially when compared with relying only on multiparametric magnetic resonance imaging prediction of seminal vesicle invasion. Conclusions A nomogram based on clinical and multiparametric magnetic resonance imaging data can predict seminal vesicle invasion and serve as a tool to urologists for surgical planning.

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

Cited by 14 publications

References 28 publications

Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy Versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension

Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy Versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension

Intensity-modulated radiotherapy for prostate cancer with seminal vesicle involvement (T3b): A multicentric retrospective analysis

Novel nomogram for the prediction of seminal vesicle invasion including multiparametric magnetic resonance imaging

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