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Friday, February 9, 2007

Seminal Vesicle Ablation

[updated January 14, 2008]

Prostate cancer normally travels from the prostate to the seminal vesicles (SV) to the lymph nodes and then the bones in its normal progression. If there is only a small chance that the cancer has spread outside the prostate then the SVs could be left in.

There is a trend in all cancers to determine what can be not removed without significantly compromising cancer control. For example, in breast cancer just a lump can sometimes be removed rather than the entire breast without materially affecting outcomes. In this vein, while Seminal Vesicles are normally removed with the prostate, there is a literature developing regarding the possibility of leaving them in and the benefits in reduced side effects. Note that SV sparing is not related to nerve sparing -- they are a completely different anatomical feature. See diagram.

The article in this link suggests that SVs should always be removed during surgery due to:

  • the possibility of "intense pain" during orgasm if they are left in and
  • being a source of PSA

Scardino writing in The Prostate Book ( seems to agree that they should be removed: "done properly the removal of the seminal vesicles does not increase the risk of incontinence or erectile dysfunction". (page 282)

However, these articles suggest continence and ED advantages to not removing them
[PMID: 16123574] [full text]
[PMID: 10840084]
[PMID: 18184337] [full text]
and this article suggests conditions under which they should or should not beremoved (namely, that if all of these hold

  • PSA is less than 10
  • GS is less than or equal to 6
  • fewer than half the cores are positive

In that case there is less than a 5% chance of SV involvement so consideration can be given to leaving them in:

Other Surgery Posts

RP vs. LRP vs. RLRP - Part 1. Open Surgery (RP)
RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery (LRP)
RP vs. LRP vs. RLRP - Part 3. Robotic Surgery (RLRP)
RP vs. LRP vs. RLRP - Part 4. What Surgeons and Others Say

Choosing a Surgeon - Part 1. Considerations
Choosing a Surgeon - Part 2. Finding a Surgeon

Lymph Node Dissection

Inguinal Hernia and Prostatectomy

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