Abstract
Objectives: To examine predictors of progression-free survival in men with seminal vesicle invasion (SVI) following radical prostatectomy (RP) for clinically localized prostate cancer. Methods and Materials: Between 1999 and 2009, 1383 men underwent RP at Indiana University. Among them, 115 men were identified with SVI. Disease progression was defined by a rise in PSA ≥ 0.2 ng/ml, receipt of salvage therapy, progression to metastatic disease, or death. After excluding 13 patients for receiving adjuvant therapy, 102 were stratified according to surgical margin (SM) and lymph node (LN) status for Kaplan-Meier analysis of disease progression. Cox proportional hazards analyses of biochemical progression-free survival were undertaken with respect to margin status, pre-operative prostate specific antigen (PSA), tumor volume, age, and post-operative Gleason sum. Stem and leaf plot was undertaken for tumor volume by biochemical PFS. Results: Mean age was 61 years, median Gleason sum was 7, mean tumor volume was 9.7 ml, and mean pre-operative PSA was 13.6 ng/ml. Mean time to disease progression was 17 months. Mean follow-up was 37 months. Kaplan-Meier analysis revealed statistically insignificant differences in progression-free survival stratified by SM and LN status (p = 0.12). Cox univariate analyses revealed tumor volume to be a statistically significant predictor of progression free survival (p = 0.02). Stem and Leaf plot revealed tumor volume to be statistically significantly larger in patients who experienced biochemical recurrence, compared to those who did not. Conclusion: Tumor volume was associated progression-free survival in this cohort of SVI patients, while pathologic Gleason sum, PSA, margin and nodal status were not.
Highlights
Seminal vesicle invasion (SVI) is identified in approximately 3% of prostatectomy specimens in the contemporary prostate-specific antigen (PSA) era [1]
While increased tumor volume has not been shown to be an independent predictor of survival on multivariate analysis of robust radical prostatectomy (RP) data sets, these data sets were largely comprised of patients without seminal vesicle invasion (SVI), and these data sets did not examine the prognostic significance of tumor volume with specific reference to SVI patients [2,3]
Mean followup was 37 months, 81.3% had a pelvic lymph node dissection at time of prostatectomy, and the margin-positive rate was 43%. 56 (54.9%) patients experienced biochemical recurrence, 43 (42.2%) patients were without evidence of biochemical recurrence at last follow-up, and 3 (2.9%) patients received salvage radiation and were deemed to have recurred
Summary
Seminal vesicle invasion (SVI) is identified in approximately 3% of prostatectomy specimens in the contemporary prostate-specific antigen (PSA) era [1]. While increased tumor volume has not been shown to be an independent predictor of survival on multivariate analysis of robust radical prostatectomy (RP) data sets, these data sets were largely comprised of patients without SVI, and these data sets did not examine the prognostic significance of tumor volume with specific reference to SVI patients [2,3]. Other studies have sought clarification of the pathologic factors predictive of survival in patients with seminal vesicle invasion ,yet overlooked the prognostic value of tumor volume [1,4,5,6,7,8]. This paper seeks to further explore the clinico-pathologic parameters predictive of progression-free survival (PFS) in patients with SVI, with specific reference to tumor volume
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