A Case Report and Literature Review: When Should We Treat the Seminal Vesicles in Prostate Cancer?

The most common cancer in men is prostate cancer. Treatment options for prostate cancer consist of radiation therapy, active surveillance, chemotherapy, and surgical intervention. In this case, radiation therapy was used, but it can lead to adverse effects ranging from fatigue, impacted sexual function, genitourinary side effects such as dysuria or nocturia, and gastrointestinal side effects such as nausea, abdominal pain, or diarrhea. Minimizing the treatment only to areas with PET-positive disease and those with a significant risk of microscopic involvement, therefore reducing radiation exposure, can help mitigate side effects and help maintain the patient's quality of life. Here, we examine a man with prostatic adenocarcinoma. A prostate-specific membrane antigen (PSMA)-PET scan was used to determine if the seminal vesicles demonstrated any evidence of disease and if treatment of the area was necessary. A PSMA-PET scan showed invasion of the seminal vesicles; thus, the seminal vesicles were included as a target for radiation therapy. The patient tolerated the treatment with minimal side effects. This case reviews the indications for treating the whole seminal vesicle.