PROGNOSTIC INDICATORS IN PATIENTS WITH SEMINAL-VESICLE INVOLVEMENT FOLLOWING RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE-CANCER

Purpose: We identify prognostic factors in patients with seminal vesic le involvement and negative lymph nodes following radical prostatectom y for clinically localized prostate cancer. Materials and Methods: A t otal of 93 patients who underwent radical prostatectomy and had semina l vesicle invasion without lymph node metastasis were evaluated. Patie nts who underwent neoadjuvant/adjuvant hormonal or radiation therapy w ere excluded from study. Preoperative serum prostate specific antigen (PSA), biopsy and radical prostatectomy specimen Gleason score, surgic al margin status, presence of extraprostatic extension and evidence of biochemical disease progression were determined prospectively. Bioche mical failure was defined as a single serum PSA elevation greater than 0.4 ng./ml. Results: The presence of positive surgical margins (p = 0 .001), and Gleason score 7 or higher from preoperative biopsies (p = 0 .03) and from the radical prostatectomy specimen (p = 0.01) were signi ficant predictors of disease progression at, a median followup of 43.3 months. Patients with preoperative PSA less than 10 ng./ml. had a bet ter disease-free survival (p = 0.07). On multivariate analysis, after adjusting for biopsy Gleason score, prostatectomy Gleason score and se rum PSA, positive surgical margins remained a statistically significan t predictor of disease progression (p = 0.002). Conclusions: Surgical margin status is an independent predictor of disease recurrence in pat ients with seminal vesicle involvement and negative lymph nodes follow ing radical prostatectomy. Serum PSA 10 ng./ml. or greater and specime n Gleason score 7 or greater also were adverse prognostic factors in t hese patients. Conversely, patients with negative surgical margins and lymph nodes have a better prognosis than previously expected, despite seminal vesicle invasion.