Abstract
We aimed to evaluate the prognostic value of seminal vesicle invasion (SVI) on preoperative multiparametric MRI (mpMRI) in pathological T3b prostate cancer (PCa). We retrospectively reviewed the clinical data of patients who underwent preoperative mpMRI and subsequent radical prostatectomy (RP). A total of 159 patients with pathologic T3b PCa were stratified into two groups based on mpMRI findings (negative vs. positive SVI). A positive SVI was defined as the presence of mpMRI evidence of SVI. In addition, 290 patients with pathologic T3a were also included in this study for further comparative analysis. Fifty-two patients (32.7%) had a positive SVI on preoperative mpMRI. Biochemical recurrence (BCR) occurred in a total of 45 (28.3%) patients, with 25 (23.4%) cases in the negative SVI group and 20 (38.5%) cases in the positive SVI group. Kaplan-Meier survival analysis of the two groups revealed significantly decreased BCR-free survival in the positive SVI group (median, 21 vs. 9 months, log-rank test, P < 0.001). On multivariate Cox regression analysis, pre-biopsy PSA (P = 0.035) and positive SVI on preoperative mpMRI (P = 0.049) were identified as significant predictors of BCR. Upon further comparative analysis with the pathologic T3a group, we also found significant differences among the groups throughout the Kaplan-Meier curve (P < 0.001). Conclusively, the unpredicted (negative) SVI group had a favorable BCR-free survival compared to the positive SVI group. In addition, significant differences were observed in the prognosis of pathologic T3a and these two groups. This suggests that pathologic T3b can be stratified into two categories.
Highlights
We aimed to evaluate the prognostic value of seminal vesicle invasion (SVI) on preoperative multiparametric MRI in pathological T3b prostate cancer (PCa)
There were no significant differences in the other variables, including age, body mass index (BMI), pathologic extracapsular extension (ECE), and lymph node invasion (LNI)
The guideline jointly revised by the European Association of Urology, the European Society for Radiotherapy and Oncology, and the International Society of Geriatric Oncology has recommended that multiparametric MRI (mpMRI) can be used in high-risk localized and locally advanced PCa, as detecting SVI can affect further treatment decisions[21]
Summary
We aimed to evaluate the prognostic value of seminal vesicle invasion (SVI) on preoperative multiparametric MRI (mpMRI) in pathological T3b prostate cancer (PCa). A total of 159 patients with pathologic T3b PCa were stratified into two groups based on mpMRI findings (negative vs positive SVI). On multivariate Cox regression analysis, pre-biopsy PSA (P = 0.035) and positive SVI on preoperative mpMRI (P = 0.049) were identified as significant predictors of BCR. Hegde et al.[14] reported that mpMRI evidence of SVI was the only significant predictor of BCR (hazard ratio [HR], 13.98; P = 0.006) in patients with high-risk PCa treated with a combination of high-dose-rate brachytherapy and external beam radiotherapy. The aim of the present study was to evaluate the prognostic role of SVI on preoperative mpMRI in pathological T3b PCa patients at RP. We performed a comparative analysis between pathologic T3a and T3b patients according to the status of SVI on mpMRI
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