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Seminal vesicle involvement at salvage radical prostatectomy
Author(s) -
Meeks Joshua J.,
Walker Marc,
Bernstein Melanie,
Eastham James A.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12034
Subject(s) - medicine , prostate cancer , prostatectomy , urology , brachytherapy , external beam radiotherapy , biochemical recurrence , biopsy , radiation therapy , stage (stratigraphy) , cancer , radiology , paleontology , biology
Objective To describe the incidence and clinical outcomes of seminal vesicle invasion ( SVI ) at salvage radical prostatectomy ( SRP ) and to describe the accuracy of SV biopsy. As SRP is used after biochemical recurrence ( BCR ) of prostate cancer after radiotherapy ( RT ) to gain local oncological control. The SVs receive lower doses of radiation from external‐beam RT ( EBRT ) to avoid rectal exposure and are not targeted with brachytherapy ( BT ) with low‐risk prostate cancer.Patients and MethodsSRP was performed on 206 men with BCR after RT at a tertiary care institution between 1998 and 2011. Post‐ RT biopsy and SRP specimens were reviewed by a genitourinary pathologist.ResultsSVI was detected in 65 (32%) of 206 patients. No difference was found between EBRT alone (65% vs 63%) and BT (29% vs 31%) with or without EBRT in patients with SVI . Men with SVI had higher rates of c T 3 disease (20% vs 8%) and G leason score ≥ 8 at SRP (52% vs 21%). BCR ‐free survival at 5 years was 18% and 56% in patients with and without SVI (hazard ratio 2.85, 95% confidence interval 1.87–4.36, P < 0.001), yet the rate of local recurrence was low (11%). Prostate cancer was identified in nine of 18 patients who underwent SV biopsy and was the only location of prostate cancer in two patients.ConclusionsSVI is a prognostic indicator for BCR after SRP , but local recurrence in patients with SVI after SRP remains low. We recommend SV biopsy to improve staging and cancer detection in men with BCR after radiotherapy.