Targeted Seminal Vesicles Biopsies: Incidence and Clinicopathological Findings
Katherine E Watts, Cristina Magi-Galluzzi. Cleveland Clinic, Cleveland, OH
Background: Invasion of prostatic adenocarcinoma (PCA) into seminal vesicles (SV) is generally accepted as an index of poor prognosis. SV are not routinely biopsied for evaluation of PCA, however some clinicians choose to include SV biopsies (SVB) along with prostate biopsies (PBx) in certain clinical scenarios. The aim of this study was to review our experience with targeted SVB in the diagnosis and management of PCA.
Design: All patients who underwent targeted SVB at our institution between 1995 and July 2012 were retrieved from the pathology electronic archives. Histological findings, reason for SVB, previous treatment [radiation (XRT), androgen deprivation therapy (ADT), cryotherapy (CRYO), brachytherapy (BRACHI)], and clinical follow up were reviewed.
Results: Of the 170 (0.8%) men with targeted SVB identified in our database, 164 (96%) had SV tissue present in the biopsy specimen. Eighty-three (51%) men with SVB had been previously diagnosed with PCA and 77 (47%) had been formerly treated for PCA: 40 had received XRT, 6 XRT+ADT, 19 BRACHY, 9 CRYO, and 3 ADT. SVB were involved by PCA (SVI) in 22 (13%) patients, 9 (5%) of whom were biopsied for the first time due to elevated PSA. Atypical glands, suspicious for cancer were detected in 1 case (0.6%). In 16 (10%) cases only SV were sampled, of which 3 (19%) showed SVI: 14 (87%) of the patients had been previously diagnosed with PCA; a SV mass was incidentally detected on CT in another case. In 11 (7%) men SVB were performed prior to XRT and in 42 (26%) prior to CRYO. The 9 (5%) men with PCA detected in SV biopsied for the first time due to elevated PSA were managed as follows: 4 received XRT+ADT, 1 orchiectomy, 1 ADT + radical prostatectomy (RP), 1 RP + salvage XRT, 1 received no treatment due to metastatic esophageal cancer, and one case was lost at follow-up.
Conclusions: Targeted SVB are not a common procedure in the evaluation for PCA extension and staging. However, SV involvement was found in 13% of patients undergoing SVB. Most of these patients had been previously treated for PCA and were being considered for additional therapy, but 9 (5%) were found to have SVI on initial biopsy for elevated PSA, highlighting the potential prognostic implications of SVB at initial diagnosis. Positive SVB results can aid in the selection of treatment options and in the prediction of outcome for individual patients by providing confirmation of locally advanced disease.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 155, Monday Afternoon