Influence of Preoperative Positive Seminal Vesicle Biopsy on the Staging of Prostatic Cancer

Abstract

A total of 71 patients with clinically localized prostatic cancer underwent preoperative biopsy of each seminal vesicle. Group 1 (67 patients) underwent 2 seminal vesicle biopsies before lymph node dissection and vesiculo-prostatectomy, while group 2 (4 patients) underwent seminal vesicle biopsy and lymph node dissection before radiation therapy. In group 1 there were 11 positive biopsies (16.5%) with a median prostate specific antigen (PSA) level of 24 ng./ml. (range 11 to 45). Of the biopsies 56 were normal, with a median PSA level of 11.8 (range 3.5 to 88, p < 0.008). Histological examination of the seminal vesicles on the prostatectomy specimen revealed 18 cases of seminal vesicle invasion (sensitivity 61%, specificity 100%, positive predictive value 100% and negative predictive value 87.5%). A positive biopsy was correlated with the mean tumor volume (10.3 cc with positive biopsies versus 4.9 cc with negative biopsies) and local invasion (positive margins in 36% versus 9%, respectively, and capsular perforation in 81% versus 25%, respectively). In group 2 the 4 seminal vesicle biopsies and lymph node dissections were positive. Overall (groups 1 and 2), positive seminal vesicle biopsies were predictive of lymph node involvement in 47% of the cases versus 7% when biopsies were negative (p > 0.001). The postoperative course was significantly different (local recurrence and metastases in 45% versus 9%, respectively, and median interval 8.8 months versus 18.3 months, respectively, p < 0.001). Seminal vesicle biopsy appears to have a satisfactory yield only in cases with a PSA level of greater than 10 ng./ml. A positive seminal vesicle biopsy confirms the presence of extraprostatic invasion of clinically localized cancer in a given patient. Seminal vesicle biopsy allows for better staging of prostatic cancer.

Use of Three Additional Mid Biopsies to Improve Local Assessment of Prostate Cancer in Patients with One Positive Sextant Biopsy

“…Tumor aggressiveness is reflected by the Gleason score [3]; tumor volume can be estimated from the number of positive biopsies, by tumor length of the positive biopsies and location of these positive biopsies [4, 5, 6, 7]. The risk of metastasis is assessed on the basis of perinervous involvement [13], capsular effraction [14]and seminal-vesicle invasion [15]. …”

Indications for Preoperative Seminal Vesicle Biopsies in Staging of Clinically Localized Prostatic Cancer

“…Conclusions: In a patient with clinically localized prostatic adeno carcinoma who is a candidate for radical prostatectomy, seminal vesicle biop sies are useless when basal prostatic biopsies are negative, regardless of the state of other preoperative parameters. When 1 or 2 basal prostatic biopsies are positive, seminal vesicle biopsies can improve the pretreatment pathologi cal staging.with large, poorly differentiated tumors, capsular inva sion, and lymph node métastasés [3][4][5][6][7]. Unfortunately, these data are only available postoperatively after patho logical examination of the radical prostatectomy speci men.…”

Value of Ultrasound-Guided Systematic Sextant Biopsies in Prostate Tumor Mapping

“…Sextant biopsies can also give abundant information for prognostic staging before radical prostatectomy: The Gleason score and number of positive biopsies, length and percentage of tumor in positive biopsies, presence of capsular effraction or perinervous involvement, and positive seminal vesicle biopsies are used to predict the pathological stage of prostate cancer before radical prostatectomy [4, 5, 6, 7, 8, 9, 10, 11]. …”

“…The risk of metastasis is assessed on the basis of perinervous involvement, capsular effraction and seminal vesicle invasion [9, 10, 11]. Some information is also given by the location of positive biopsies, and this can lead to additional biopsies or modified radical prostatectomy with preservation of the neurovascular bundle or combined lymphadenectomy [12, 13, 14].…”