title: Seminal vesicle involvement at salvage radical prostatectomy.
abstract: OBJECTIVE
  To describe the incidence and clinical outcomes of seminal vesicle invasion (SVI) at salvage radical prostatectomy (SRP) and to describe the accuracy of SV biopsy. As SRP is used after biochemical recurrence (BCR) of prostate cancer after radiotherapy (RT) to gain local oncological control. The SVs receive lower doses of radiation from external-beam RT (EBRT) to avoid rectal exposure and are not targeted with brachytherapy (BT) with low-risk prostate cancer.
  
  
  METHODS
  SRP was performed on 206 men with BCR after RT at a tertiary care institution between 1998 and 2011. Post-RT biopsy and SRP specimens were reviewed by a genitourinary pathologist.
  
  
  RESULTS
  SVI was detected in 65 (32%) of 206 patients. No difference was found between EBRT alone (65% vs 63%) and BT (29% vs 31%) with or without EBRT in patients with SVI. Men with SVI had higher rates of cT3 disease (20% vs 8%) and Gleason score ≥ 8 at SRP (52% vs 21%). BCR-free survival at 5 years was 18% and 56% in patients with and without SVI (hazard ratio 2.85, 95% confidence interval 1.87-4.36, P < 0.001), yet the rate of local recurrence was low (11%). Prostate cancer was identified in nine of 18 patients who underwent SV biopsy and was the only location of prostate cancer in two patients.
  
  
  CONCLUSIONS
  SVI is a prognostic indicator for BCR after SRP, but local recurrence in patients with SVI after SRP remains low. We recommend SV biopsy to improve staging and cancer detection in men with BCR after radiotherapy.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
authors.forename: Marc
authors.initials: M
authors.lastname: Walker
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects*; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods; D012669:Seminal Vesicles / Q000473:pathology* / Q000528:radiation effects; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen