Preperitoneal vas deferens infiltration in high-risk prostate cancer

Ali Serdar Gözen; Antonios Koudonas; Samet Senel; Maurizio Colecchia; Jens Rassweiler

doi:10.1002/bco2.289

Preperitoneal vas deferens infiltration in high-risk prostate cancer

BJUI Compass. 2023 Sep 17;5(1):159-165. doi: 10.1002/bco2.289. eCollection 2024 Jan.

Authors

Ali Serdar Gözen¹, Antonios Koudonas², Samet Senel³, Maurizio Colecchia⁴, Jens Rassweiler⁵

Affiliations

¹ Department of Urology Medius Kliniken Ruit Ostfildern Germany.
² First Department of Urology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece.
³ Department of Urology Ankara City Hospital Ankara Turkey.
⁴ Department of Pathology Vita Salute University San Raffaele Milan Italy.
⁵ Department of Urology Danube Private University Krems Austria.

Abstract

Objectives: The objective of this study is to evaluate the prevalence and the importance of preperitoneal vas deferens (VD) infiltration in high-risk prostate cancer (PCa).

Patients and methods: In this prospectively designed study, we included 332 high-risk PCa patients with a Briganti score >5%, who were treated by robot-assisted radical prostatectomy between July 2017 and February 2022 at the Urology Department, SLK Kliniken Heilbronn. In addition to the standard histological analysis of the distal VD, which was attached to the prostate specimen, we analysed the infiltration status of preperitoneal VD in this cohort. The preperitoneal VD, which represents the middle part of ductus deferens and extends between the internal inguinal ring and obturator fossa, was resected during extended pelvic lymphadenectomy. Distal and preperitoneal VD status was registered together with preoperative and postoperative disease characteristics. Descriptive analysis methods and logistic regression analysis were used.

Results: Briganti score of the target cohort had a median value of 19%, while 235 patients (70.8%) of the group demonstrated a locally advanced disease. The Grade Group at prostatectomy specimen was at least 3 for 286 patients (86.1%). Distal VD infiltration was found in 20 patients (6%) and preperitoneal VD infiltration in two patients (0.6%). Distal VD infiltration was not associated with an increased possibility for positive surgical margins or nodal status among pT3b patients, while both patients with preperitoneal VD infiltration were characterized by highly aggressive disease in locally advanced stage and bilateral distal VD infiltration.

Conclusions: PCa extension along VD may reach a more proximal point of VD than the reported from the existing data infiltration of VD adjacent to seminal vesicles. This rare manifestation of PCa local extension may be the intermediate step to the rare cases of recurrence in the testicles. However, more robust data are needed to confirm the aforementioned hypothesis. Distal VD infiltration seems to have no additional prognostic value among patients with infiltrated seminal vesicles.

Keywords: invasion; local extension; preperitoneal space; prostate cancer; vas deferens.