Session: MP67: Prostate Cancer: Localized: Surgical Therapy III
MP67-06: Outcomes of Prostate Cancer Patients with Seminal Vesicle Invasion at Multiparametric MRI Managed with Radical Prostatectomy. Do All Patients Really Need a Multi-modal Approach?
Introduction: The presence of seminal vesicle invasion (SVI) at multiparametric MRI (mpMRI) represents one of the strongest risk factors for disease recurrence after radical prostatectomy (RP). According to international guidelines, in patients with suspicion of SVI surgery can be offered only in the context of a multi-modal approach. We hypothesized that a subset of men with SVI at imaging might be instead managed with RP only. Methods: Overall, 4,334 patients diagnosed with MRI-targeted and concomitant systematic biopsy who underwent radical prostatectomy (RP) with or without an extended pelvic lymph node dissection (PLND) at 10 tertiary referral centers worldwide. Among those, we selected men with SVI at mpMRI who did not receive neoadjuvant or adjuvant treatments (n=169). Clinical and preoperative imaging variables were available for all patients. Biochemical recurrence (BCR) was defined as two consecutive PSA =0.2 ng/ml. Kaplan-Meier analyses assessed time from surgery to BCR. Cox regression analyses assessed the impact of preoperative imaging and clinical characteristics on the risk of BCR. Results: Median PSA at diagnosis was 11.5 ng/ml. The median maximum diameter of the index lesion was 20 mm. Overall, 49 (29%) patients had multifocal disease at mpMRI. A total of 62 (37%) and 28 (17%) patients had grade group 4-5 and cT3 disease at DRE, respectively. The median follow-up for survivors was 20 months. Overall, 27 patients experienced BCR. The 3-year BCR-free survival was 75%. Biopsy Grade Group 4-5 (HR: 2.2; 95%CI: 1.1-4.8; p=0.04) and the presence of cT3 at DRE (HR: 2.3; 95%CI: 1.1-5.5; p=0.04) were significant predictors of BCR after adjusting for PSA value at diagnosis and maximum diameter of the index lesion. The BCR-free survival rate was significantly higher for those with biopsy Grade Group 1-3 organ-confined disease (n=79, 47%) compared to their counterparts with biopsy Grade Group 4-5 or cT3 (n=88, 53%; 3-year BCR-free survival: 87% vs. 61%; p=0.015). Conclusions: The prognosis of patients with SVI at mpMRI managed by RP alone is not invariably poor. Men with biopsy Grade Group =3 with organ-confined disease have a substantially lower risk of BCR compared to Grade Group >3 or cT3 and can be considered as the ideal candidates for surgery as monotherapy. SOURCE OF Funding: none
