Primary adenocarcinoma of the seminal vesicles

Purpose: We provide an overview of seminal vesicle carcinoma, a rare entity that is difficult to diagnose and traditionally has been associated with a poor prognosis. Materials and Methods: A literature search for seminal vesicle carcinoma was performed, and current concepts related to the diagnosis and clinical management were reviewed. Two unpublished additional cases recently treated at our institution were added to the international experience. Special attention was given to new developments in diagnostic methods. Histopathological changes and biomarker criteria are provided to allow accurate diagnosis of this condition. Results: Early diagnosis of seminal vesicle carcinoma has often been difficult due to a lack of immunohistochemical markers that distinguish this entity from invasive adenocarcinoma of adjacent organs. A total of 49 documented cases of seminal vesicle carcinoma in men between 19 and 90 years old has been reported in the current literature. Two additional cases that were diagnosed and treated at our institution are incorporated into this review. Recently the tissue marker CA 125 has substantially increased the accurate diagnosis of seminal vesicle carcinoma. In addition, increased serum CA 125 in patients with this disease has been reported and serum levels correlate well with the clinical course of the disease. Radical surgery in combination with adjuvant radiotherapy or androgen deprivation has resulted in long-term palliation in some patients with advanced disease. Conclusions: Including seminal vesicle carcinoma in the differential diagnosis of lower urinary tract symptoms will improve detection. Improved imaging tools and the availability of a serum marker will undoubtedly enhance detection at the earliest stages. More defined histopathological criteria will allow diagnosis even with small biopsy specimens. Radical surgery appears to offer the best chance for cure but hormonal manipulation and radiotherapy seem to be effective as adjuvant treatment modalities.