Preoperative Parameters in Predicting Seminal Vesicle Involvement in Patients with Prostate Cancer. Is Complete Seminal Vesicle Resection Necessary in Every Patient Undergoing Radical Prostatectomy?

Thomas J Guzzo, Manish Vira, Yanlin Wang*, Tomaszewski John*, Alan J Wein, S. Bruce Malkowicz
University of Pennsylvania, Philadelphia, PA

Introduction: Dissection of the seminal vesicles (SVs) during radical prostatectomy (RP) can contribute to increased morbidity including erectile dysfunction and incontinence. The purpose of this study was to evaluate the clinical parameters associated with a positive SV finding on final pathology and identify those patients with minimal risk of SV involvement.
Methods: A prospective database of 1056 patients undergoing RP from 1991-1999 was interrogated to evaluate the incidence and clinical correlates of SV invasion. Variables studied included preoperative serum PSA, percent positive biopsy cores, DRE and biopsy Gleason score. Statistical analysis included univariate, multivariate regression analysis and receiver operating characteristic (ROC) curves. Classification and Regression Trees (CART) were also employed in an attempt to create an algorithm for predicting patients in whom SV involvement would be unlikely.
Results: Of our 1056 patients, 79 (7.4%) had SV involvement. Of the 356 patients with <17% positive biopsies, only two (0.5%) had SV involvement on final pathology. Preoperative PSA, biopsy Gleason score and percent positive biopsies were all highly predictive of SV invasion on multivariate analysis (p<0.0001). Percent positive biopsy was found to be the single best predictor of positive seminal vesicle pathology (p<0.0001). CART models were able to predict a larger cohort of patients with no SV pathology, but with less sensitivity than percent positive biopsy alone.
Conclusion: Stage migration and potential surgical morbidity makes complete SV resection less compelling than in the past. Preoperative parameters may accurately predict those patients at low risk for SV involvement, yet this requires prospective validation.

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