Elsevier

Urology

Volume 72, Issue 6, December 2008, Pages 1224-1228
Urology

Biopsy and Pathological Predictors of Outcome
Prognostic Significance of Cancer Volume Involving Seminal Vesicles in Patients With pT3bpN0 Prostate Cancer

https://doi.org/10.1016/j.urology.2008.06.055Get rights and content

Objectives

To investigate the prognostic effect of the prostate cancer (PCa) volume involving the seminal vesicles (CVSVs) in the radical prostatectomy specimen from patients with Stage pT3bpN0 PCa.

Methods

We retrospectively reviewed the clinical records of 27 patients with Stage pT3bpN0 PCa who had undergone radical prostatectomy alone. We measured the CVSVs using a grid method on the glass slide under microscopic inspection and investigated the association of the CVSVs with clinicopathologic variables.

Results

Prostate-specific antigen (PSA) failure was confirmed in 11 of the 27 patients (41%) during a median follow-up of 34 months. The 3-year PSA failure-free survival rate was 48%. The median CVSVs was 1.14 cm3. On univariate analysis, a CVSVs of >1.63 cm3 was associated with positive surgical margins (P = .018), bilateral seminal vesicle involvement (P = .03), a long maximal tumor dimension (P = .031), and a greater preoperative PSA level (P = .0007). The 3-year PSA failure-free survival rate for those with a CVSVs of ≤1.63 cm3 vs >1.63 cm3 was 80% and 0%, respectively (P = .0009). On multivariate analysis, only the PSA level and CVSVs were identified as significant and independent predictors of PSA failure. Stratifying patients into 3 risk groups by these predictors, the PSA failure-free survival rate for patients with a PSA level ≥10 ng/mL and a CVSVs of >1.63 cm3 was significantly worse than for any other group.

Conclusions

The CVSVs is useful and invaluable as an independent predictor of PSA failure in patients with Stage pT3bpN0 PCa. The measurement of the CVSVs is simple and helped to determine the indication for adjuvant treatment after radical prostatectomy.

Section snippets

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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