Linzer D G, Stock R G, Stone N N, Ratnow R, Ianuzzi C, Unger P
Department of Radiation Oncology, Mount Sinai Hospital, New York, New York, USA.
Urology. 1996 Nov;48(5):757-61. doi: 10.1016/S0090-4295(96)00422-0.
Seminal vesicle biopsy (SVB) is a new technique for detecting the spread of prostate cancer to the seminal vesicles. A comparison of findings following SVB in patients undergoing radiation therapy with pathologic findings following radical retropubic prostatectomy (RRP) was made to evaluate the accuracy of this test and its use in the staging of prostate cancer.
Four hundred nine patients with clinically localized adenocarcinoma of the prostate gland were evaluated for treatment: 222 patients underwent SVB prior to radiation therapy and 187 patients underwent RRP. Clinical stages in patients undergoing SVB included T1a (1 patient), T1b (4), T1c (35), T2a (49), T2b (96), and T2c (37); RRP clinical stages included T1b (3 patients), T1c (48), T2a (57), T2b (66), and T2c (13). The Gleason scores in patients undergoing SVB were 2 to 4 in 50 men, 5 to 6 in 110 men, and 7 and greater in 62 men; the Gleason scores in patients undergoing RRP were 2 to 4 in 53 men, 5 to 6 in 94 men, and 7 and greater in 40 men. Prostate-specific antigen (PSA) values ranged from 1.3 to 190 ng/mL (median 10.75) in men undergoing SVB and ranged from 0.5 to 140.6 ng/mL (median 9.0) in men undergoing RRP.
The overall incidence of seminal vesicle involvement as determined by the two techniques was the same. Seminal vesicle involvement was found in 33 of 222 patients (15%) undergoing SVB and in 27 of 187 (14%), of the RRP specimens (P = 0.9). When the two groups were further divided by three prognostic categories (clinical stage, PSA level, and grade), there was no difference in the incidence of seminal vesicle involvement between the two methods, except in the patients with Gleason score of 4 or less. In these patients, 5 of 53 (9%) had seminal vesicle involvement in the RRP group, compared with none of the 50 men in the SVB group (P = 0.02). Disease that was not organ confined was found in 69 of 187 prostatectomy specimens (37%). Of these patients, 27 of 69 (39%) had seminal vesicle involvement.
SVB is an accurate method of detecting seminal vesicle invasion based on comparisons with radical prostatectomy findings. Its importance lies in its ability to detect a large percentage of patients with non-organ-confined disease and in its use in modifying treatment planning accordingly.
精囊活检（SVB）是一种检测前列腺癌向精囊扩散的新技术。对接受放射治疗的患者进行SVB后的结果与根治性耻骨后前列腺切除术（RRP）后的病理结果进行比较，以评估该检测的准确性及其在前列腺癌分期中的应用。
对409例临床局限性前列腺腺癌患者进行治疗评估：222例患者在放射治疗前接受了SVB，187例患者接受了RRP。接受SVB的患者临床分期包括T1a（1例）、T1b（4例）、T1c（35例）、T2a（49例）、T2b（96例）和T2c（37例）；RRP临床分期包括T1b（3例）、T1c（48例）、T2a（57例）、T2b（66例）和T2c（13例）。接受SVB的患者中，Gleason评分2至4分的有50例，5至6分的有110例，7分及以上的有62例；接受RRP的患者中，Gleason评分2至4分的有53例，5至6分的有94例，7分及以上的有40例。接受SVB的男性前列腺特异性抗原（PSA）值范围为1.3至190 ng/mL（中位数10.75），接受RRP的男性PSA值范围为0.5至140.6 ng/mL（中位数9.0）。
两种技术确定的精囊受累总体发生率相同。在接受SVB的222例患者中有33例（15%）发现精囊受累，在RRP标本的187例中有27例（14%）（P = 0.9）。当两组进一步按三个预后类别（临床分期、PSA水平和分级）划分时，两种方法在精囊受累发生率上没有差异，除了Gleason评分为4分或更低的患者。在这些患者中，RRP组53例中有5例（9%）精囊受累，而SVB组50例中无一例受累（P = 0.02）。在187例前列腺切除标本中有69例（37%）发现疾病超出器官局限。在这些患者中，69例中有27例（39%）精囊受累。
基于与根治性前列腺切除术结果的比较，SVB是检测精囊侵犯的准确方法。其重要性在于它能够检测出很大比例的疾病超出器官局限的患者，并相应地用于调整治疗计划。
