Types of Seminal Vesicle Invasion (SVI)

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K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 3/5/2011 12:33 AM (GMT -6)   

Update from K2

 

I'm scheduled for a radical prostatectomy in a couple weeks. The ultrasound suggests SVI - stage 3 cancer.

 

Age = 51

Gleason = 3 + 4 (6 core 85% involved average)

PSA = 16

 

With my PSA level I was expecting a higher Gleason score, as was my doctor - I can only hope it holds in the post operation samples. Since so much of the biopsy samples contained cancer cells (85%) the pathologist had ample tissue to find higher score cells. Therefore I'm thinking my Gleason score might hold. But I know upgrades are not rare in post op analysis.

 

Of course I'll will know a lot more following the RP - namely lymph node involvement and type of SVI.

 

Dr. Patrick Walsh's book seems to indicate little benefit of a RP with SVI. I've read a several studies that disagree. Apparently one benefit to younger men is the prostrate is much smaller (my case) leaving more tissue to cut at the margins. And there seems to be a somewhat statically significant benefit to eliminating the cancerous mass.

 

Apparently there are several types of SVIs - some (?) with somewhat more favorable statistics. Does anyone have details differentiating these SVI types?

 

I could use a dose of HW wisdom right about now.

 

K2


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7665
   Posted 3/5/2011 1:23 AM (GMT -6)   
K2,
This is a very controversial topic. I was positive bilaterally with the seminal vesicles and even my surgeon has wavered a bit on the topic. He believes that stage III and stage IV guys are the ones who will benefit most with RP and that's a different thought than what he told me in 2006. He now tries to avoid surgery on the Gleason 6 guys ~ deferring most of them to active surveillance. He has stated that you can treat in any number of ways or not treat the G6 guys and get the same 10 years results. But that clearly there is a survival benefit to treating the intermediate and high risk guys ~ with extensive lymph node dissection ~ especially the SVI positive guys who have no evidence of distant mets.

Dr. Walsh has a reputation of screening his cases for the G6 guys and won't do surgery on an SVI guy. Totally the opposite.

As for me we took it out. I have not had that relapse.

I'll stick with my guys recommendations.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 3/5/2011 2:38 AM (GMT -6)   
Tony,

There doesn't seem to be to much on T3 in HW. I've read about radiation after RP BEFORE a PSA failure as a relatively new aggressive treatment option for T3 patients. But, again it's hard to get a bearing on what is substantiated and what is merely hopeful.

K2

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7665
   Posted 3/5/2011 3:20 AM (GMT -6)   
K2,
I assume you mean clinical T3 or cT3. No most of our guys identified their T3 status through surgical removal. We have quite a few cT4's, however.

Adjuvant radiation after RP has been around a while. I decided that was the rout for me in 2007 after reading studies that were six years old. Radiation after surgery is a newer approach but it is because of improvements in radiation delivery techniques. Before IMRT we had EBRT and it was messy. IMRT fixed a lot of morbidity issues making it safer to consider it as an adjuvant therapy. And todays technologies are even better.

But there are also a lot of doctors who don't subscribe to adjuvant therapies until there is a PSA rise. Until there is Level 1 studies that show the survival benefit the controversy will remain. There is study going on by two major universities (Harvard and Stanford) but they are Level II prospective studies. Still the early data appears to show extended biochemical failure rates and survival benefit.

Geez...My wife and I went to dinner tonight with an RO that was the chief resident at the Harvard radiation center 6 or so years ago. I forgot to ask him for the latest data on that stuff.

Must have been the wine...

Tony

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2087
   Posted 3/5/2011 6:33 AM (GMT -6)   
Not heard of any different types of SVI.
Interesting that is was spotted with ultrasound (I have never heard of it being picked up at biopsy, as I was under the impression that uros try to avoid jabbing needles in there duringa biopsy.)

It was my (one-sided) SVI that meant I was not surprised that surgery was not enough to get me into the Zero club.

RT aimed at the prostate bed and thus at the edges of whee the SVI had been as well did get me into the zero club. The hope is thus that the cancer cells were simply moving slowly along that path via the seminal vesicles and not leaping about all over the place, and that my PSA will stay down.

It was still a bit of a shock to get a post-op pathology that was so much worse than what the biopsy found.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr CT
66Gy 28 Apr to 11 Jun 10
Tired + weird BMs
14 Sep 10 PSA <0.1
12 Jan 11 PSA <0.1
Erection OK

Post Edited (English Alf) : 3/5/2011 4:36:45 AM (GMT-7)


mr bill
Regular Member


Date Joined Sep 2010
Total Posts : 476
   Posted 3/5/2011 8:18 AM (GMT -6)   
I am also going through RT at this time after RP last September. My PSA was undectable as recent as January 20, 2011.  However, on December 2, 2010 the uro surgeon recommended RT within 1 month without HT. He is one of the top in the U.S. and told me he had nothing to back up his opinion in the way of studies, etc., but was going with his gut feeling.
 
 As you can see I did have SVI.
 
I feel from reading, listening, experience, that it is difficult to track this disease. I do not think anyone can accurately predict where it will show up next.  There are tests/scans that might help, but nothing is cast in stone.
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not Rx finasteride
2007 acute urine retention photovaporize Clev. Clinic Rx finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive,
seminal & vas deferens +
RT started 2-17-11
PSA 3 wk .06, 6 wk <.03, 12wk 0.0

K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 3/5/2011 11:24 AM (GMT -6)   

Tony,

 

You had both adjuvant radiation therapy an adjuvant hormone therapy (Casodex and Lupron) before waiting to see if there would be a post RP rise in PSA?  I fully anticipate my post op will suggest I'm a poor candidate for the zero club with RP alone - it would seem prudent to just keep blasting this thing.

 

And yes I'm cT3 due to both lobes involved. My high percentage biopsy involvement 85% ave. (all 6 cores) is also an adverse finding. As I mentioned previously my Gleason = 3 + 4 was a wee tiny bit of kind of good news if it holds. From what I gather with a cT3 prostate there's a pretty small probability of getting a lower Gleason score. My general doctor told me I did have a fairly good free PSA but I've yet to get the number - perhaps that played a role.

 

Obviously at this point SVI is only suspected from the ultrasound, which did look sketchy on my left side and given the volume of cancer in the prostrate it seems quite plausible. My urologist seem to think it was indicative of SVI.

 

A while back I stumbled across a study discussing a few different ways SVI can present its self but I don't seem to have saved it. My urologist indicated internal invasion was preferable - which sounds logical. Better confined to an organ than not -especially if you don't need the organ.

 

Make a toast to me when you celebrate St. Patrick's day as I'll be having my RP  : )

 

Best

 

K2

 

 


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2354
   Posted 3/5/2011 12:28 PM (GMT -6)   
K2, you are trying to play this game two or three hands ahead..You can drive yourself crazy and worry yourself sick doing that..This disease is just too unpredictable to try and predict outcomes very far ahead..Lots of guesswork at this point...The "maybe" and "what if" stuff is really counter-productive...You will be better off just playing the cards you hold in your hand NOW..Concentrate on winning THIS HAND before you start worrying about the NEXT hand..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

axle
Regular Member


Date Joined Feb 2011
Total Posts : 35
   Posted 3/7/2011 11:21 AM (GMT -6)   
K2, like you, I am also wondering about what is in store for my future. My post-Op pathology revealed SVI and EPE on the right side. But, my margins of excision were clear. Also, my Uro cut out two margin samples which also were negative. So, my post-Op pathology is good news bad news sort of like what you think about what your ultrasound indicated. My post-Op pathology report also stated that my R. seminal vesicle was removed and all there. Interestingly, my L. SV was not all accounted for. But my PCa was mostly all on my R. side so that is more good news.

Although it sometimes is difficult not to worry about being presented with information that increases your risk of future complications and treatment, I agree with others that have said to wait for the cards to be dealt to play your hand.
Age 58; da Vinci on 1/26/2011
PSA History: 10/2005 = 1.7; 10/2007 = 2.8; 10/2009 = 3.6; 10/2010 = 4.9
Abnormal DRE in 2009; Increasingly abnormal DRE in 2010
Thank you POPs!
Biopsy on 11/23/2010: GS = 3+4 (right side) with 4 of 6 cores positive @ 40%.
Post-OP pathology: GS=3+4; tumor = 35%; pT3b; R. seminal vesicle invasion; Extraprostatic extension into the R. bladder neck; margins uninvolve

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3733
   Posted 3/7/2011 12:23 PM (GMT -6)   
Did Your doctor use the Partin tables or the Nomograms to give a probability that the PC is not contained. Since there is a high degree that you will have to have salvage radiation did you look into the option of seeds/IMRT which is effective in high risk cases such as yours. and has the advantage of eliminating one set of side affects. Surgery is effective in sampling lymphnodes, but unfortunately the lymphnodes that are most likely to be affected by seminal vessicle invasion are not easily sampled and there is a greater than 50% chance that these infected nodes will be missed.
Did your doctor give you a PAP test and a PCA3 test. PAP is the best pronosticator of micromets followed by Gleason score and psa. If your PAP is high then you might want to reconsider your treatment options.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7665
   Posted 3/7/2011 5:59 PM (GMT -6)   
@K2's post posted 3/5/2011 8:24 AM (GMT -8),
First let me apologize for the slow response. It was race weekend here in Las Vegas so to avoid the crowd I headed out into the desert riding ATV's.

Yes I took on the "dam the torpedoes" approach and fired away at this thing. I knew what the stakes were without the adjuvant therapies and at the age of 44 I didn't like them. So we took an aggressive approach that almost included adjuvant chemotherapy with Taxotere and prednisone. Sounds pretty radical, and it would have been considered so, but to me it was radical to think that surgery alone was going to get me to age 80. I know a great deal more now than when I made my decision choices and I am glad I went the rout I did without the chemo.

I'll certainly toast ya on St. Patricks day but it's during Lent and my glass won't contain alcohol (my own sacrifice) but that's a good thing as I am close to dropping my weight below 200 pounds for the first time since 2004. LOL...My goal for this adjuvant weight loss is 185 by my BD on June 26th.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino
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