INDICATIONS FOR SEMINAL-VESICLE BIOPSY AND LAPAROSCOPIC PELVIC LYMPH-NODE DISSECTION IN MEN WITH LOCALIZED CARCINOMA OF THE PROSTATE

Purpose: The ability of seminal vesicle biopsy and laparoscopic pelvic lymph node dissection to identify patients with stage T3 or N+ disease before undergoing treatment for localized carcinoma of the prostate was investigated. Materials and Methods: A total of 157 patients with clinical stages T1a to T2c prostate cancer underwent ultrasound guided seminal vesicle biopsy (3 on each side) and 130 underwent subsequent laparoscopic pelvic lymph node dissection. Results: Of 157 patients 23 (14.6%) had a positive seminal vesicle biopsy. Predictors of a positive seminal vesicle biopsy were stages T2b to T2c versus T1a to T2a disease (20% versus 4%, respectively, p = 0.005), Gleason score 7 or more versus less than 7 (34% versus 9%, respectively, p < 0.0001) and prostate specific antigen (PSA) 4 to 10 ng./ml., 10 to 20 ng./ml. or more than 20 ng./ml. (9%, 14% and 27%, respectively, p = 0.03). Of 130 patients 14 (10.7%) had a positive laparoscopic pelvic lymph node dissection. Predictors for a positive laparoscopic pelvic lymph node dissection were Gleason score 7 or more versus less than 7 (32% versus 12%, respectively, p < 0.0001), PSA more than 20 ng./ml. or less than 20 ng./ml. (24% versus 4.5%, respectively, p = 0.009) and stage T2b or T2c (15% and 24%, respectively, p = 0.056). Of the patients with a positive seminal vesicle biopsy 48% had a positive laparoscopic pelvic lymph node dissection (p < 0.0001). Conclusions: All patients with a Gleason score more than 4, PSA more than 10 ng./ml. or clinical stage T2b or more should undergo seminal vesicle biopsy, and those with a positive seminal vesicle biopsy or Gleason score 7 or greater should undergo laparoscopic pelvic lymph node dissection before initiating therapy for localized carcinoma of the prostate.