Seminal Vesicle Invasion

[MyDad76]

Hi everyone, it has been a while since I wrote, but I do follow the site quite regularly.

My dad (79, no comorbidity) has prostate cancer. He was diagnosed five years ago 4+3=7. His only therapy so far was hormone one - first casodex (bicalutamide) and now for the past 2 and a half years eligard every six month.

About 8 months ago he also received an urinary catheter (foley), as he is retaining too much urine.

Preparations for radiation started 6 months ago and now finally when he was about to start, latest MR scan showed: very likely right seminal vesicle invasion and his case will now be evaluated at consilium of radiologist at oncology center. We do not have PSMA PET scan in our country.

His PSA is rising steadily and is now at 2.11 and he is considered castrate resistant. I should add that his PSA at its highest (when diagnosed) was 5.2. Second line hormone therapy was not yet approved, it might be now as seminal vesicle invasion is highly suspected.

Anyone with similar experience? What kind of treatment did you receive for semi vascular invasion? What kind of questions should I ask to doctors?

Thank you in advance for all your insights.

[GP24]

They can radiate the prostate including the seminal vesicles. They should place fiducials in these to target them well.

However, I would prefer surgery because he probably will not need the catheter any more after that.

[meowlicious99 in reply to GP24]

what about TURP + radiation instead of surgery

[GP24 in reply to meowlicious99]

After a TURP you have the risk that a re-treatment may be required. After radiation this re-treatment is difficult and often not permanently successful.

[meowlicious99 in reply to GP24]

oh i see. I didn't know that re-TURP is difficult post radiation. Really useful info.

[tango65]

If he has not distant metastases in a bone scan and a CT scan or he has less than 3 distant metastases , they could irradiate the prostate and seminal vesicles. Prostatectomy is also an option.

[Tall_Allen]

Radiation is probably a bad idea because it carries increased risk of urinary retention. A radical TURP or prostatectomy may give him some relief of those symptoms. Has he had a bone scan?

[MyDad76 in reply to Tall_Allen]

My Dad’s cancer was discovered following TURP procedure in September 2016. Given his age, the fact that he already had TURP, they do not wish to operate him though he has no comorbidities. One doctor said that prostatectomy after several years on hormone theraphy is very difficult due to how the prostate changes. He had skeletal scintigraphy and it was clear.

[Tall_Allen in reply to MyDad76]

TURPs sometimes have to be redone. Do they have HoLEP where you are?

[MyDad76 in reply to Tall_Allen]

I had to look up what HoLEP stands for. I never heard it mentioned in all 5 years. But I will ask for sure in all the main centers that we have. His urologist just does not see a problem, I got several “second” opinions, but age plays a big role in our state health system where resources are very limited - and we have very very limited private sector with outpatient checks only, but no “full service”.

[MyDad76 in reply to MyDad76]

Unfortunatelly HoLEP is not available in our country :-(. They would like to proceed with EBRT, what puzzles me is that he would only get 20 treatments. This is the only oncology center in the country and all men with prostate cancer go through the hands of 1 radiology oncologist. So clearly he has experience, but nevertheless i feel a bit worried with how things are going. Is there anything I can / should ask him besides if he considers 20 treatments are really sufficient?

[timotur]

I had left-SV invasion, manifested by slight pain on the left side of the groin. I was treated successfully with HDR-Brachytherapy, which was able to target that area specifically (see profile).

[diamondrn]

I am 77 and had seminal vesicle involvement right out of the gate with my advanced prostate cancer. It was quite painful at first, but somehow ADT with Firmagon and Zytiga has reduced the pain in both vesicles to the point that it is no longer noticeable.

[rscic]

Seminal vesicle invasion raises the risk of distant metastasis as the seminal vesicles are very vascular and it is thought this is a common way Prostate Cancer gains access to the bloodstream.

[babychi]

Gleason 8/9 here in Australia. We had SV involvement in 2017. Zoladex x 96 weeks and 39 EBRT in 2018 and now after 3.5 years NED (no evidence of disease). Prostate removal was not an option because of seeding risk, recurrence risk, probable incontinence and ED. He is now 75, fit and fabulous. Research is key. Radiation worked for us. Great outcomes to you and Dad.🌺

[Hotrod65]

SVI typically indicates cancer has breached the prostate and outside now it may require systemic treatment now ?, chemotherapy may be on the treatment options, as well as Anti Androgens for castration resistance.

[MyDad76 in reply to Hotrod65]

Systemic second line treatment (chemo, Zytiga etc) in our country is only approved once cancer is castrate resistant and distant mets are identified. It is not approved for locally advanced cancer which is still considered curable by other methods. On my dad's last scans (MR + skeletal scintigraphy) mets were not identified, so not sure if will be already approved. For sure will request it again, but we have been denied less than half year ago.

[Seasid in reply to MyDad76]

Is your dad curable? Can they irritated his Mets also? Is he oligometastatic?