Adenocarcinoma of the prostate invading the seminal vesicle: Prognostic stratification based on pathologic parameters

Objectives. To stratify the prognosis of lymph node-negative, seminal vesic le-positive tumors in men with prostate cancer after radical retropubic pro statectomy. Methods. Sixty cases were analyzed for multiple parameters and correlated w ith postoperative biochemical (prostate-specific antigen) progression. Vari ables included Gleason score, primary Gleason pattern, percentage of Gleaso n pattern 4, any presence of Gleason pattern 5, method of seminal vesicle i nvasion (SVI), margin positivity, SVI extent, SVI bilaterality, vascular in vasion, extent of extraprostatic extension, length of tumor extending along the seminal vesicles, presence of intraductal carcinoma within the prostat e, bladder neck margin positivity, and tumor volume. Results. We were able to stratify the prognosis based on the combination of a variation of the Gleason score and margin status and vascular invasion s tatus. Using this stratification, a few patients had an excellent long-term prognosis, with most patients split into two groups, one experiencing rapi d and the other slower progression. Conclusions. SVI is not associated with a uniformly poor prognosis. Rather, tumors can be substratified by pathologic parameters into groups with diff ering prognoses based on routine histologic examination. UROLOGY 56: 283-28 8, 2000. (C) 2000, Elsevier Science Inc.