A nomogram to predict seminal vesicle invasion by the extent and location of cancer in systematic biopsy results.
ABSTRACT We determined whether systematic biopsy results increases the accuracy of standard clinical information in predicting seminal vesicle invasion (SVI).
We analyzed a retrospective cohort of 763 patients with clinical stages T1c-T3 prostate cancer who were diagnosed by systematic biopsy and treated with radical prostatectomy. We recorded the location of each biopsy core and measured the length of cancer and total length of each core. Using logistic regression analysis we constructed and internally validated a nomogram to predict SVI.
A total of 60 patients (7.9%) had SVI. Cancer was present in a biopsy core from the base in 437 patients, of whom 12.8% had SVI compared with only 1.2% of the 326 without cancer at the base. None of the 275 patients with prostate specific antigen (PSA) 10 ng/ml or less and no cancer at the base had SVI. On multivariate analysis serum PSA (p <0.0005), primary Gleason grade (p = 0.028) and percent cancer at the base (p <0.005) were the only significant predictors of SVI. The predictive accuracy of a standard model that included only stage, grade and PSA was maximally enhanced by including the percent cancer at the base (p = 0.0013). A nomogram that incorporated this variable produced probabilities of SVI that differed from the standard model by +/- 10% in 68% of the cases.
The presence and amount of cancer in systematic needle biopsy cores from the base of the prostate strongly predicts the presence of SVI. Systematic biopsy results enhance the accuracy of nomograms to predict SVI.
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ABSTRACT: Objective: To evaluate the accuracy of high-spatial resolution T2-weighted endorectal magnetic resonance imaging (eMRI) for detection and pattern depiction of seminal vesicle invasion (SVI) in patients with prostate cancer (PCa). Methods: 376 patients were included who underwent eMRI for staging before radical open prostatectomy at 1.5 T with an endorectal coil. Statistical accuracy for detection of SVI was calculated. MR images of patients with SVI were further evaluated by two radiologists according to the classification by Wheeler and Ohori. Results: In the cohort, 35 patients had SVI after histopathological evaluation of the prostatectomy specimen (stage pT3b). Sensitivity and specificity for detection of SVI were 48.6 and 97.7%, respectively. Negative and positive predictive values and overall accuracy were 94.9, 68.0, and 93.1%, respectively. Infiltration pattern analysis showed that type I invasion was most common with 48.6 followed by type IIa (31.4%) and IIb (20%). Type III was not present. There was no statistical significant difference between the three groups regarding Gleason score, age, and prostate-specific antigen level. Conclusions: eMRI with high-spatial resolution T2-weighted imaging is accurate for assessment of SVI. Depiction of different infiltration types of SVI is feasible. By adding information about the extent of SVI, diagnostic reporting and risk stratification could be improved. © 2013 S. Karger AG, Basel.Urologia Internationalis 11/2013; · 1.15 Impact Factor
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ABSTRACT: The planning CT allows the delineation of the prostate (clinical target volume, CTV) but with an imprecision at the apex and the inability to visualize the intraprostatic cancer. MRI enables accurate visualization of the prostate outlines and in some extent the intraprostatic tumour (gross tumour volume [GTV]). The integration of MRI data within the CT remains still complex. Analysis of prostatectomy specimen has guided the definition of a CTV beyond the capsule, depending on pretreatment factors. In practice, the CTV can be defined as follows: prostate-only, for good prognosis tumours; prostate (+0 to 5mm margins, excluding the rectum) and seminal vesicles (possibly limited to 2cm of their proximal region) for intermediate-risk tumours; prostate (+5mm margins) and seminal vesicles for high-risk tumours. The planning target volume (PTV) should be between 5mm and 10mm depending on the space directions, in the absence of image-guidance (IGRT). It could be reduced to 5mm in case of IGRT. In the adjuvant setting after prostatectomy, the definition of the CTV should follow the recommendations from cooperative groups. It takes into account both the analysis of pattern of local recurrence after prostatectomy, but also the specific histological analysis of the surgical specimen of the patient. The corresponding PTV margin is 6 to 8mm.Cancer/Radiothérapie 08/2013; · 1.11 Impact Factor
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ABSTRACT: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.International Urology and Nephrology 09/2013; 46(1). · 1.29 Impact Factor