¿Cuándo biopsiar las vesículas seminales?

Abstract

ObjectivesThe involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. Material and methodsobservational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. ResultsForty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P<.01) and PSA density (P<.01), as well as a lower mean prostate volume (P<.01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P<.01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P<.01), 4.65 times higher for PSA levels >19.60ng/dL (P<.01) and 2.95 times higher if there is a suspicious rectal examination (P=.014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P<.01). The ROC curves showed maximum sensitivity and specificity at 19.6ng/mL for PSA and 0.39 for PSA density. ConclusionsIn this series, greater involvement of seminal vesicles was associated with a PSA level ≥20ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.