Histopathologic features of prostate cancer in patients who underwent seminal vesicle-sparing radical prostatectomy: A novel surgical approach

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Conference Proceeding

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Modern Pathology


Background: Incontinence and erectile dysfunction are common complications of radical prostatectomy (RP). Seminal vesicle (SV) involvement is found in 5-23% of RP, frequently with grade group (GG) 3-5. At our institution a novel seminal vesicle-sparing approach (SVSRP) has been introduced, with preservation of either one or both seminal SVs in a select group of patients to improve functional outcomes. Here we report on the surgical pathology findings on SVSRP. Design: All SVSRP were reported by a specialist genitourinary pathologist. Detailed pathologic findings including grade, tumor size, number of tumor nodules, margin status, and pathologic stage were studied. Results: Specimens from 33 patients were studied with median age of 63 (range 51-80). In the diagnostic biopsy, 7 were Grade Group (GG) 1, 16 GG2, 6 GG3, 2 GG4, 1 GG5, and 1 not applicable (post hormonal therapy). Median number of biopsies taken was 12 (6-36) and median number positive biopsies was 3 (1-11). Half (16/33, 48%) had frozen section (FS) evaluation of the SV. Almost all (32/33) had bilateral sparing of SV, whereas in one FS of the SV base was positive and unilateral sparing of SV was performed. Median tumor percentage was 6% (1-30%). A dominant tumor nodule (DN) was identified in 31/33 (94%), whereas 2 had scattered microscopic tumor foci. Median size of the DN was 21 mm (11-30) and median number of secondary nodule(s) was 1 (1-6). Median GG of the DN was 2 (1-5). Positive margin was present in 20/33 (60%). However, only one (3%) had positive margin at the site of SVSRP. Median linear extent of positive margin was 3.5 mm (1-20 mm). Lymphovascular invasion was present in 2/33 (6%), 1/33 (3%) had bladder neck invasion, 1/33 (3%) had lymph node metastasis, 15/33 (45%) had extraprostatic extension, and 4/33 (12%) showed intraductal carcinoma. The case with positive margin at the SVSRP site was the case with unilateral (left) SV sparing. (Table). (Table presented) Conclusions: SVSRP is a promising surgical approach which may offer early return of continence compared to RP while allowing resection of clinically significant tumor. Although 60% of our cases had positive margins, only one case with aggressive disease had positive margin at the SVSRP site. The rest would have had positive margins with a conventional RP. Further refinement of selection criteria with additional pre-op or intra-op biopsies of the seminal vesicles may help to improve oncologic control in this surgical approach.





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