INDICATIONS FOR PREOPERATIVE SEMINAL-VESICLE BIOPSIES IN STAGING OF CLINICALLY LOCALIZED PROSTATIC-CANCER

Objective: To identify patients at high risk of extraprostatic seminal vesicle infiltration, in whom preoperative seminal vesicle biopsies s hould be performed. Materials and Methods: We studied the relationship between extraprostatic seminal vesicle infiltration and the available preoperative data [age, clinical stage, prostate-specific antigen (PS A) level, number and site of positive prostatic sextant biopsies, Glea son score] in a total of 75 patients suffering from clinically localiz ed prostatic adenocarcinoma who were candidates for radical prostatect omy. Results: The chi(2) test showed that the preoperative data most s ignificantly correlated with extraprostatic seminal vesicle infiltrati on were the presence of positive basal biopsies (p < 0.001). The PSA l evel did not have any predictive value. The most discriminant preopera tive parameter of the state of the seminal vesicles (analysis of varia nce on a univariate model) was the state of the basal prostatic biopsi es. The importance of this parameter was confirmed by cluster analysis . Overall, the risk of extraprostatic seminal vesicle invasion was 0 ( 0/21 patients) when the 2 basal prostatic biopsies were negative, 10.2 5% (4/39 patients) when 1 of the 2 basal prostatic biopsies was positi ve and 73.33% (11/15 patients) when both basal prostatic biopsies were positive. Conclusions: In a patient with clinically localized prostat ic adenocarcinoma who is a candidate for radical prostatectomy, semina l vesicle biopsies are useless when basal prostatic biopsies are negat ive, regardless of the state of other preoperative parameters. When 1 or 2 basal prostatic biopsies are positive, seminal vesicle biopsies c an improve the pretreatment pathological staging.