Microvascular invasion in prostate cancer: prognostic significance in patients treated by radical prostatectomy for clinically localized carcinoma.
OBJECTIVE
To investigate the clinical significance of vascular invasion in prostate cancer patients treated by radical prostatectomy for clinically localized and locally advanced disease.


METHODS
Vascular invasion was determined during a routine work-up of radical prostatectomy specimens of 273 patients who underwent surgery for prostatic carcinoma. The correlation with other pathological variables was investigated. The prognostic influence for clinical progression, local recurrence, distant metastases, biochemical progression, overall survival and cancer-specific survival was determined.


RESULTS
Vascular invasion was present in 33 patients (12%). Vascular invasion correlated significantly with capsular perforation, seminal vesicle invasion, positive margins of resection, perineural invasion, high grade, and pathological stage. Vascular invasion was a significant prognostic factor for clinical progression (p < 0.001), local recurrence (p = 0.007), distant metastases (p < 0.001), biochemical progression (p < 0.001), overall survival (p = 0.02), and cancer-specific survival (p < 0.001). Multivariate analysis, adjusting for capsular perforation, high grade, and positive margins of resection, showed that vascular invasion was associated with a 2.5-fold increased risk for clinical progression. This relative risk was 2.3 for biochemical progression, and 2.7 for cancer-specific survival.


CONCLUSIONS
Vascular invasion is a very important pathological variable for progression and survival, and must be evaluated on a routine basis during the work-up of radical prostatectomy specimens.
van den Ouden
D
D
Department of Urology, Erasmus University and Academic Hospital, Rotterdam, The Netherlands.
Kranse
R
R
Hop
W C
WC
van der Kwast
T H
TH
Schröder
F H
FH
D000368:Aged; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate
D017430:Prostate-Specific Antigen