Isolated seminal vesicle invasion imparts better outcomes after radical retropubic prostatectomy for clinically localized prostate cancer: prognostic stratification of pt3b disease by nodal and margin status

Abstract

Objectives: To examine the survival differences in men with seminal vesicle invasion (SVI) according to surgical margin (SM) and nodal (N) status to characterize the influence of isolated SVI on disease progression after radical retropubic prostatectomy for clinically localized prostate cancer.

Methods: We reviewed the records of 941 men who underwent radical retropubic prostatectomy for clinically localized prostate cancer between 1984 and 2002. Three groups with evidence of SVI (SM-/N-, SM+/N-, and N+) were analyzed to identify differences in age, preoperative prostate-specific antigen (PSA) level, biopsy Gleason score, surgical Gleason score, time to PSA progression, follow-up time, and cancer-specific and overall survival. Kaplan-Meier estimates and univariate and multivariate calculations were generated to examine differences in biochemical-free survival.

Results: Of 941 patients, 87 were identified with SVI; of these, 28 (32.2%) were SM-/N-, 35 (40.2%) were SM+/N-, and 24 (27.6%) were N+. The median follow-up for all patients was 70 months. The 5-year biochemical progression-free rate for SM-/N-, SM+/N-, and N+ patients was 71.9%, 36.6%, and 25.9%, respectively. The median time to PSA progression for SM-/N-, SM+/N-, and N+ patients was 26, 16, and 6 months, respectively. The clinical stage, pretreatment PSA level, and margin and node status were statistically predictive (P < 0.05) on univariate analyses; however, only positive margin status approached statistical significance on multivariate analysis (P = 0.06). The overall and cancer-specific 5-year survival rates for SM-/N-, SM+/N-, and N+ patients were 89% and 100%, 79% and 97%, and 78% and 86%, respectively.

Conclusions: Isolated SVI is associated with lower rates of, and longer intervals to, biochemical failure compared with SVI with positive margins and/or regional lymph node involvement.