Is it necessary to remove the seminal vesicles completely at radical prostatectomy? decision curve analysis of European Society of Urologic Oncology criteria.
OBJECTIVE
A publication on behalf of the European Society of Urological Oncology questioned the need for removing the seminal vesicles during radical prostatectomy in patients with prostate specific antigen less than 10 ng/ml except when biopsy Gleason score is greater than 6 or there are greater than 50% positive biopsy cores. We applied the European Society of Urological Oncology algorithm to an independent data set to determine its predictive value.


METHODS
Data on 1,406 men who underwent radical prostatectomy and seminal vesicle removal between 1998 and 2004 were analyzed. Patients with and without seminal vesicle invasion were classified as positive or negative according to the European Society of Urological Oncology algorithm.


RESULTS
Of 90 cases with seminal vesicle invasion 81 (6.4%) were positive for 90% sensitivity, while 656 of 1,316 without seminal vesicle invasion were negative for 50% specificity. The negative predictive value was 98.6%. In decision analytic terms if the loss in health when seminal vesicles are invaded and not completely removed is considered at least 75 times greater than when removing them unnecessarily, the algorithm proposed by the European Society of Urological Oncology should not be used.


CONCLUSIONS
Whether to use the European Society of Urological Oncology algorithm depends not only on its accuracy, but also on the relative clinical consequences of false-positive and false-negative results. Our threshold of 75 is an intermediate value that is difficult to interpret, given uncertainties about the benefit of seminal vesicle sparing and harm associated with untreated seminal vesicle invasion. We recommend more formal decision analysis to determine the clinical value of the European Society of Urological Oncology algorithm.
Secin
Fernando P
FP
Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers and Department of Epidemiology and Biostatistics (AC, AJV), Memorial Sloan-Kettering Cancer Center, New York, New York.
Bianco
Fernando J
FJ
Cronin
Angel
A
Eastham
James A
JA
Scardino
Peter T
PT
Guillonneau
Bertrand
B
Vickers
Andrew J
AJ
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001707:Biopsy, Needle; D015331:Cohort Studies; D003661:Decision Support Techniques; D005060:Europe; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D016019:Survival Analysis; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen