Histopathologic features of prostate cancer in patients who underwent seminal vesicle-sparing radical prostatectomy: A novel surgical approach
Alhamar M, Hassan O, Sood A, Arora S, Jeong W, Williamson S, Menon M, and Gupta N. Histopathologic features of prostate cancer in patients who underwent seminal vesicle-sparing radical prostatectomy: A novel surgical approach. Modern Pathology 2020; 33(3):849-850.
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.