Role of Seminal Vesicles in Prostate Cancer

Introduction

Seminal vesicles are a pair of small tubular glands that produce a fluid mixed with semen. These glands are located above the prostate, behind the bladder, and in front of the rectum. One is positioned at the left and the other at the right. Each of them is around two inches long on average.

What Is Prostate Cancer?

When cancer occurs in the prostate, it is called prostate cancer. The prostate is a gland that is seen in males. It is a part of the male reproductive system. It is a walnut-shaped gland that produces a fluid called seminal fluid. The location of the prostate gland is below the bladder. This fluid helps in the nourishment and transportation of the sperm.

Prostate cancer is regarded as one of the most typical cancers. Cancerous growth occurs when the body's normal cells are replaced by cancerous cells. People with prostate cancer often find difficulty in peeing, loss of bladder and bowel control, pain while ejaculating, blood found in the semen, etc.

What Are the Risk Factors Associated With Prostate Cancer?

The risk factors associated with prostate cancer are

• Age: It is an important factor causing prostate cancer. As the person ages, the risk of developing prostate cancer increases, especially after 50. It is seen that around 60 percent of prostate cancer develops after the age of 65.

• Family History of Prostate Cancer: In case of a family history of prostate cancer, the chances of developing prostate cancer increase by two to three percent.

• Race and Ethnicity: In black or African people over the age of 50 years, the prevalence is higher.

• Genetics: If mutated (changed) genes are inherited, with an increased risk of developing breast cancer (BRCA1 and BRCA2).

The other factors associated with prostate cancer are:

• Smoking.

• Prostatitis.

• BMI (body mass index) >30 (having obesity).

• STIs (sexually transmitted infections).

What Is the Role of Seminal Vesicles in Prostate Cancer?

Seminal vesicle invasion (SVI) is found in most cases of prostate cancer. SVI is referred to as the secondary involvement of seminal vesicles and ductus deferens (also known as vas deferens, a part of the male genital organ that helps in the transportation of sperms) by the neoplasm which does not originate actually from seminal vesicles and is even more common than their primary counterparts.

According to the TNM (tumor, node, and metastases) staging of cancer, prostate cancer is staged at T3b when seminal vesicles get involved. The seminal vesicle invasion (SVI) is referred to as a tumor infiltrate, which is caused by the external tumor cells; to a broader extent, inflammation also results in seminal vesicle infiltration.

What Is the Epidemiology of Seminal Vesicle Invasion in Prostate Cancer?

• Prostate cancer is the most common cancer leading to seminal vesicle involvement.

• In some rare situations, the seminal vesicle invasion is seen in the case of rectal cancer or bladder cancer.

• In approximately ten percent of cases of prostate cancer, seminal vesicle involvement is seen.

The invasion of seminal vesicles in prostate cancer is usually associated with and considered a type of extraprostatic (extracapsular) extension of prostate cancer (a growth that occurs beyond the pseudo capsule of the prostate gland).

What Is the Clinical Presentation of Seminal Vesicle Invasion?

The symptoms associated with the invasion of seminal vesicles in prostate cancer are very uncertain. One of them includes hematospermia, a clinical symptom that could be associated with the involvement of seminal vesicles, for example, in the cynical context of prostate cancer, but can also occur in many benign conditions. In the case of prostate cancer, some clinical parameters suggestive of the prediction of the seminal vesicle invasion are as follows:

• High prostate-specific antigen (PSA) is used nowadays as the marker for prostate adenocarcinoma.

• Prostate cancer's presence in the biopsy core from the base.

• High ipsilateral biopsy Gleason grade (describes the histological pattern of gland arrangement).

• High ipsilateral percentage core involvement.

In pathologic correlates of the malignant seminal vesicle invasion occurs by tumor infiltration of the muscular wall of the seminal vesicle.

What Are the Routes Associated With Seminal Vesicle Invasion?

Different suggested routes or subtypes associated with the invasion of seminal vesicles have been described. For prostate cancer, they can be listed below:

• Tumor extension via the ejaculatory duct.

• Tumor extension or spread from the prostatic base or the adjacent fatty tissue.

• Isolated tumor deposits.

What Are the Radiographic Features Associated With Seminal Vesicle Involvement?

Available radiographic features associated with seminal vesicle involvement are:

• Enlargement of seminal vesicles or mass.

• Loss in the architecture of seminal vesicles.

• The boundaries of seminal vesicles get irregular, and adjacent fat plane infiltration occurs.

• The prostate-seminal angle gets lost.

How Is the Seminal Vesicle Invasion in Prostate Cancer Diagnosed?

The seminal vesicle invasion in prostate cancer is diagnosed with the help of

• Ultrasound: It might show the mass that extends into the seminal vesicles or loss in the prostate-seminal vesicle angle.

• MRI (Magnetic Resonance Imaging): This is the most accurate method of determining the SVI. It reveals features such as tumor infiltration.

• CT (Computed Tomography) Scan: It reveals features in ultrasound, like a soft tissue mass extending into one of the seminal vesicles.

What Is the Treatment of Seminal Vesicle Invasion in Prostate Cancer?

The treatment is possible with:

• Hypofractionated Radiotherapy With Image-Guided Intensity-Modulated Radiotherapy (IMRT):

This technique uses a computer-controlled linear accelerator to deliver precise radiation doses to specific areas within a tumor.

• Conventional Radiotherapy:

It is a common type of cancer treatment that uses high-energy particles, such as x-rays, gamma rays, electron beams, or protons, to squeeze tumors and kill cancer cells by damaging their DNA (deoxyribonucleic acid)

• Androgen Deprivation Therapy:

Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made by the testicles. It is primarily used for the treatment of prostate cancer.

Conclusion

This article provides details of the role of seminal vesicles in prostate cancer, its symptoms, radiographic features, routes, diagnosis, and treatment. Prostate cancer occurs in the prostate gland, which is found in males. Seminal vesicles are glands that produce a fluid mixed with semen. They are located above the prostate. The involvement of the muscular wall of the seminal vesicle is usually seen after prostatectomy. It is noted in such patients, and the prognosis is also poor. It can be diagnosed with the help of ultrasound, CT scan, or MRI. The treatment can be done as per the staging of the cancer; for example, radiotherapy, and androgen deprivation therapy are also required.