Background:
Seminal vesicle invasion (SVI) by prostate cancer has classically been considered to cause high prostate-specific antigen (PSA) failure rates after radical retropubic prostatectomy (RRP). Previous reports have identified pathologic Gleason score of 4+3 or greater, preoperative PSA greater than 20 ng/dL, and positive surgical margins as predictors of time to PSA-failure. We report the PSA-failure free survival of patients undergoing RRP for clinically localized prostate cancer with SVI.
Methods:
A query of the Albany Medical Center Cancer Database identified individuals with SVI prostate cancer diagnosed after RRP (1998-2004). A retrospective chart review was then performed. 18 patients with SVI were identified. PSA-failure free survival was determined using the actuarial method of Kaplan and Meier for patients who had none, one, two, or all three predictors of time to PSA-failure.
Results:
18 patients with a mean age of 65.7 years demonstrated SVI in RRP specimens. The mean preoperative PSA was 9.79 ng/dL (4.3 - 24.5), while 2 patients (11%) had a preoperative PSA > 20 ng/dL. The surgical specimens demonstrated a mean Gleason score of 7.16 (7-8), and positive surgical margins were present in 11 (61%). At a mean follow-up of 44.8 months, 6 (33%) remained free from disease.
The 44 month estimate of PSA-failure free survival was 100%, 0%, 14% and 20% for patients with no predictors versus having one, two, or all three predictors of the time to PSA failure (Figure 1).
Interestingly, of the four patients (22%) that demonstrated SVI with negative surgical margins and preoperative PSA < 20 ng/dL irrespective of pathologic Gleason score, 3 (75%) remained PSA-failure free at a mean follow-up of 53.5 months (18.7 - 78).
Conclusions:
The PSA-failure free survival after RRP for patients with SVI varies depending on preoperative PSA, prostatectomy Gleason score, and surgical margin status. In those patients with only SVI, the majority remain disease free, arguing against immediate adjuvant treatment strategies.

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