title: Prognostic value of seminal vesicle involvement due to prostate cancer in radical prostatectomy specimens.
abstract: OBJECTIVE
  To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy.
  
  
  METHODS
  We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model.
  
  
  RESULTS
  A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P=.001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P<.0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P<.0001). The predictors within the pT3b patient group were: PSA levels >10 ng/mL (HR: 1.9; 95% CI: 1.04-3.6; P=.04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P=.03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P=.004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS (pathological Gleason score 8-10 and PSA levels >10 ng/mL). This model confirms that pT3b tumors are a heterogeneous group, which includes an important group with better prognosis when surgical treatment is performed.
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España. Electronic address: ralgarra@unav.es.
authors.forename: R
authors.initials: R
authors.lastname: Algarra
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: J
authors.initials: J
authors.lastname: Barba
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: I
authors.initials: I
authors.lastname: Merino
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: A
authors.initials: A
authors.lastname: Tienza
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: E
authors.initials: E
authors.lastname: Tolosa
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: J E
authors.initials: JE
authors.lastname: Robles
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: J
authors.initials: J
authors.lastname: Zudaire
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002454:Cell Differentiation; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Antígeno prostático específico; Biochemical progression; Cáncer de próstata; Gleason; Progresión bioquímica; Prostate cancer; Prostate-specific antigen; Rescue therapy; Terapia de rescate