Stratification of Seminal Vesicle Invasion as Prognostic Factors in Prostate Cancer
Mioko Okayasu, Hiroyuki Takahashi, Toshihiro Yamamoto, Bungo Furusato, Sainosuke Mizukami, Shin Egawa, Hiroshi Hano. Jikei University School of Medicine, Tokyo, Japan
Background: Seminal vesicle invasion (SVI) of prostate cancer has been generally associated with poor prognosis, although the details of SVI vary cases to cases. In the current International Society of Urological Pathology consensus on handling and staging of radical prostatectomy specimens, no further stratification of SVI is defined. In this study, we evaluated various histopathological factors of SVI to see whether they were useful as prognostic predictors.
Design: A total of 798 radical prostatectomy specimens obtained from 2004 to 2011 in our institution were evaluated. The cases with neoadjuvant therapies were excluded. The cases with SVI were retrieved and histological review was performed. Route of invasion (Type 1-3 in the previous report by Ohori et al), Gleason score of SVI (GS-SVI), tumor area of SVI, lymphovascular invasion at SVI (LVI-SVI), degrees of SVI (muscular wall level: MW, mucosal level: M, and mucosal destructive: MD), laterality of SVI, surgical margin status at SV, length of positive surgical margin at SVI, perineural invasion in SV, overall GS and surgical margin status, extraprostatic extension, and lymph node metastasis status were evaluated as possible risk factors for biochemical recurrence (BCR: defined as a single rise of serum PSA level ≥0.2 ng/mL after surgery). Univariate and multivariate Cox proportional hazards models were adopted for statistical analysis.
Results: The incidence of SVI was 8.8% (70/798 cases) and 41.4% (29/70) of those experienced BCR. The GS-SVI distributed as 6 in 4.3% (3/70), 7 in 58.6% (41/70), and 8-10 in 37.1% (26/70), respectively. In 2.8% (5/70), GS-SVI was higher than overall GS and 3 of them experienced BCR. As a route of invasion, type 1, 2, 3, and multiple routes, were found in 12.9% (9/70), 12.9% (9/70), 32.9% (23/70), and 40.0% (28/70), respectively, with 1 undeterminable case. As degrees of SVI, MW, M, and MD invasion were found in 42.9% (30/70), 44.3% (31/70), and 12.9% (9/70), respectively. On univariate analysis, LVI-SVI and MD invasion were significantly associated with higher risk for BCR (HR 3.24, 95%CI 1.12-9.3, p=0.03; HR 2.60, 95%CI 1.04-6.4, p=0.04). Multivariate analysis identified that LVI-SVI was significantly associated with higher risk for BCR (HR 3.05, 95%CI 1.06-8.8, p=0.04). Other factors were not associated with the risk.
Conclusions: The risk of BCR in SVI positive cancer patient is not uniform. LVI-SVI is a suggestive stratified factor for the evaluation of outcome in pathological stage 3b prostate cancer.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 76, Tuesday Morning