INDICATIONS FOR SEMINAL-VESICLE BIOPSY AND LAPAROSCOPIC PELVIC LYMPH-NODE DISSECTION IN MEN WITH LOCALIZED CARCINOMA OF THE PROSTATE

Purpose: The ability of seminal vesicle biopsy and laparoscopic pelvic lymph node dissection to identify patients with stage T3 or N+ diseas e before undergoing treatment for localized carcinoma of the prostate was investigated. Materials and Methods: A total of 157 patients with clinical stages T1a to T2c prostate cancer underwent ultrasound guided seminal vesicle biopsy (3 on each side) and 130 underwent subsequent laparoscopic pelvic lymph node dissection.Results: Of 157 patients 23 (14.6%) had a positive seminal vesicle biopsy. Predictors of a positiv e seminal vesicle biopsy were stages T2b to T2c versus T1a to T2a dise ase (20% versus 4%, respectively, p = 0.005), Gleason score 7 or more versus less than 7 (34% versus 9%, respectively, p < 0.0001) and prost ate specific antigen (PSA) 4 to 10 ng./ml., 10 to 20 ng./ml. or more t han 20 ng./ml. (9%, 14% and 27%, respectively, p = 0.03). Of 130 patie nts 14 (10.7%) had a positive laparoscopic pelvic lymph node dissectio n. Predictors for a positive laparoscopic pelvic lymph node dissection were Gleason score 7 or more versus less than 7 (32% versus 12%, resp ectively, p < 0.0001), PSA more than 20 ng./ml. or less than 20 ng./ml . (24% versus 4.5%, respectively, p = 0.009) and stage T2b or T2c (15% and 24%, respectively, p = 0.056). Of the patients with a positive se minal vesicle biopsy 48% had a positive laparoscopic pelvic lymph node dissection (p < 0.0001). Conclusions: All patients with a Gleason sco re more than 4, PSA more than 10 ng./ml. or clinical stage T2b or more should undergo seminal vesicle biopsy, and those with a positive semi nal vesicle biopsy or Gleason score 7 or greater should undergo laparo scopic pelvic lymph node dissection before initiating therapy for loca lized carcinoma of the prostate.