Seminal vesicle injury during radical prostatectomy does not affect the oncological outcome of prostate cancer patients

Seminal vesicle invasion (SVI; stage T3b) in prostate cancer (PCa) patients is associated with a worse prognosis compared to extraprostatic tumor extension (pT3a). For reasons remaining largely unknown, patients with stage T3b have a higher risk of progression, metastatic dissemination and death from PCa than patients stage pT3a. The SVs have been shown to provide a favorable microenvironment for tumor progression. During radical prostatectomy (RP), injury to the SV leads to leakage of SV fluid, providing a potential breeding ground for PCa cells. To our knowledge, the effect of intraoperative SV injury on the oncological outcome has not been investigated. Herein, we report on oncological outcome in patients with and without documented intraoperative SV injury. A total of 1,139 consecutive PCa patients undergoing RP between 2005 and 2023 were included in this single-center study. The presence/absence of SV injury during RP was documented. SV injury was defined as any tear/incision of the SVs resulting in leakage of SV fluid. Clinical endpoints were progression-free survival (PFS; defined as biochemical recurrence free survival) and cancer-specific survival (CSS). 1,086 (95.4%) patients received robotic-assisted RP. 4.6% of patients underwent open (n=48) or perineal (n=5) RP. Intraoperative SV injury occurred in 358 patients (31.4%) while the SV stayed intact in 781 patients (68.2%). Clinico-pathological characteristics did not significantly differ between the two patient groups including the presence of histopathologically proven SVI. Over a follow-up period of >10 years, no differences in PFS (p=0.779) and CSS (p=0.364) were observed. There was also no difference in local recurrence between the two groups (p=0.697). During follow-up, six patients (0.5%) died from PCa. Intraoperative SV injury had no effect on the oncological outcome of PCa patients in our cohort; even when SVI, stage ≥ pT3a disease, and/or positive surgical margins were present.