Biopsy and Pathological Predictors of OutcomePrognostic Significance of Cancer Volume Involving Seminal Vesicles in Patients With pT3bpN0 Prostate Cancer
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Patient Population
We retrospectively reviewed the clinical records of 463 Japanese patients with clinically localized or locally advanced PCa who had undergone RP and bilateral lymphadenectomy limited to the obturator fossa without neoadjuvant treatment from February 1994 to March 2007 at our institution. SVI was confirmed pathologically in 40 of the 463 patients (8.6%). Of these 40 patients, 11, with lymph node metastasis, and 2, who had received adjuvant treatment, were excluded from this study. The remaining
Routes of Invasion into SVs
Of the 27 cancers, 15, 10, and 2 were type II, I+II, and I, respectively. No case was classified as type III. Six cancers (22%) had bilateral SVI.
Association of CVSVs With Clinicopathologic Variables
The CVSVs ranged from 0.16 to 4.88 cm3 (median 1.14). Table 1 lists the association of the CVSVs with the clinicopathologic variables. On univariate analysis, a CVSVs >1.63 cm3 was associated with positive surgical margins, bilateral SVI, a greater maximal tumor dimension, and a greater preoperative PSA level, but not with age.
Association of CVSVs With Oncologic Outcomes
During a median
Comment
We have demonstrated for the first time that the CVSVs in the RP specimen is a predictor of PSA failure in patients with Stage pT3bpN0 PCa. After adjusting for PSA level, the risk of PSA failure increased 7.5-fold for the patients with CVSVs >1.63 cm3. Only a few studies have analyzed the predictors of PSA failure in patients with Stage pT3bpN0 PCa.13, 15, 16 Ohori et al.13 reported that patients with type I SVI have a worse prognosis than those with type III in a cohort that included patients
Conclusions
The results of our study have shown that the CVSVs is a strong predictor of PSA failure in patients with pT3bN0 PCa and superior to the established criteria of SVI previously reported. Systemic adjuvant treatment might be indicated for patients with a preoperative PSA level >10 ng/mL and CVSVs >1.63 cm3.
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