Urothelial carcinoma of the bladder with seminal vesicle invasion: Prognostic significance

OBJECTIVE To evaluate the prognostic impact of seminal vesicle invasion in men who underwent radical cystectomy for bladder cancer. PATIENTS AND METHODS Of the 610 patients who underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from 1989 to 2008, 60 male patients who had pathological stage T4 disease were divided into three groups: prostatic stromal invasion only (Group A, n= 35), seminal vesicle invasion regardless of prostatic stromal invasion (Group B, n= 19), and rectum or pelvic wall invasion (Group C, n= 6). We assessed the effect of several variables on recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS The 2- and 5-year RFS rates for the entire cohort were 33.5% and 22.5%, respectively, and the 2- and 5-year CSS rates were 48.0% and 23.6%, respectively. Median RFS (6.6 months vs 26.3 months, P < 0.001) and CSS (14.5 months vs 35.9 months, P= 0.005) were significantly shorter for Group B than for Group A, but were similar in Groups B and C (6.6 months vs 8.8 months, P= 0.859 and 14.5 months vs 11.8 months, P= 0.613, respectively). On multivariate analysis, seminal vesicle invasion was an independent predictor of RFS (hazard ratio 2.94, 95% CI 1.40-6.17, P= 0.004) and CSS (2.63, 1.21-5.70, P= 0.014), along with pathological nodal status (3.90, 1.64-9.28, P= 0.002 and 4.39, 1.79-10.76, P= 0.001) and adjuvant therapy (2.76, 1.31-5.82, P= 0.008 and 4.14, 1.86-9.23, P= 0.001). CONCLUSION Seminal vesicle invasion by urothelial carcinoma of the bladder is a poor prognostic indicator for RFS and CSS. The prognosis of patients with seminal vesicle invasion mimics that of patients with pT4b bladder cancer.