Saihara Kazushi, Sanuki Naoko, Hashimoto Yoshimasa, Tochigi Kosuke, Hayakawa Akira, Tomioka Sadafumi, Nara Yoshiharu, Maruyama Kunihiro
Department of Radiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.
Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan.
Rep Pract Oncol Radiother. 2025 Jun 7;30(2):216-222. doi: 10.5603/rpor.105863. eCollection 2025.
In definitive radiotherapy for localized prostate cancer, the seminal vesicle is included in the target volume for intermediate- and high-risk cases, though this increases the risk of toxicity to the bowel and rectum. This study retrospectively examined clinicopathological data to assess the absence of seminal vesicle invasion (SVI) in prostate cancer patients without radiological evidence of SVI using preoperative magnetic resonance imaging (MRI).
Patients with cT1c-cT3a prostate cancer who underwent radical prostatectomy between March 2010 and February 2024 were retrospectively selected, excluding those with distant metastasis, missing MRI data, preoperative systemic therapy, or delayed surgery post-biopsy. Preoperative risk factors [age, initial prostate-specific antigen (PSA), grade group (GG), clinical T stage, positive core ratio] and postoperative pathology were analyzed to assess SVI risk. The impact of GG changes between biopsy and postoperative pathology on risk classification and SVI treatment intensity in radiotherapy was also examined.
Of 368 patients, 308 met the inclusion criteria. SVI was observed in 26 patients (8.4%). Significant predictors of SVI included GG, initial PSA ≥ 8.6, and positive core ratio, with a positive core ratio < 0.5 and GG ≤ 3 indicating an SVI risk under 10%. GG discrepancies between biopsy and surgery were noted in 182 cases (59.1%), but had minimal impact on risk classification and SVI risk.
Patients with a positive core ratio <0.5 had a low risk of SVI. GG discrepancies did not significantly underestimate prostate cancer risk, minimizing the risk of failing to treat true SVI.
在局限性前列腺癌的根治性放疗中，对于中高危病例，精囊被纳入靶区，尽管这会增加肠道和直肠的毒性风险。本研究回顾性分析临床病理数据，以评估术前磁共振成像（MRI）未显示精囊侵犯（SVI）影像学证据的前列腺癌患者是否存在SVI。
回顾性选取2010年3月至2024年2月期间接受根治性前列腺切除术的cT1c - cT3a前列腺癌患者，排除有远处转移、MRI数据缺失、术前全身治疗或活检后手术延迟的患者。分析术前危险因素[年龄、初始前列腺特异性抗原（PSA）、分级组（GG）、临床T分期、阳性穿刺核心比例]及术后病理，以评估SVI风险。还研究了活检与术后病理之间GG变化对放疗风险分类和SVI治疗强度的影响。
368例患者中，308例符合纳入标准。26例（8.4%）观察到SVI。SVI的显著预测因素包括GG、初始PSA≥8.6以及阳性穿刺核心比例，阳性穿刺核心比例<0.5且GG≤3表明SVI风险低于10%。182例（59.1%）患者活检与手术之间存在GG差异，但对风险分类和SVI风险影响极小。
阳性穿刺核心比例<0.5的患者SVI风险较低。GG差异未显著低估前列腺癌风险，将漏诊真正SVI的风险降至最低。
