Abstract
Current published data regarding the prognostic value of microvascular invasion (MVI) in patients with prostate cancer (PCa) have yielded mixed results. Furthermore, most important series had surgical procedures performed by multiple surgeons and surgical specimens analyzed by multiple pathologists. We determined the relation of MVI with other pathologic features and whether this finding can be used as an independent prognostic factor in patients with PCa. We selected 428 patients with clinically localized PCa treated with radical prostatectomy (RP). MVI was correlated to other pathologic features. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. Eleven percent out of the 428 patients presented MVI. Except for the lack of association with biopsy Gleason score, MVI was related to all clinical and pathologic features of RP specimens. Mean follow up after surgery was 53.9 +/- 20.1 months. Patients with MVI presented a recurrence rate of 44.6% compared to only 20.2% for patients without MVI (Log-rank test - p < 0.001). After Cox regression analysis, MVI was an independent prognostic feature related to biochemical recurrence. MVI is associated to advanced pathologic features of PCa and is an important prognostic factor regarding disease recurrence in patients treated with RP. These findings support the recommendations to the routine evaluation of this variable in pathologic reports of RP specimens.
Highlights
Despite surgical treatment, almost 30% of the patients presenting clinically localized prostate cancer (PCa) will develop elevation of serum prostate specific antigen (PSA) in a 10 years follow up period [1]
According to recommendations of the College of American Pathologists Cancer Committee since 1994, microvascular invasion (MVI) is reported in radical prostatectomy (RP) specimens [3], even though mixed results regarding its incidence and prognostic significance are reported in literature
The most important series had surgical procedures performed by multiple surgeons and surgical specimens analyzed by multiple pathologists, leading to possible interpretation biases
Summary
Almost 30% of the patients presenting clinically localized prostate cancer (PCa) will develop elevation of serum prostate specific antigen (PSA) in a 10 years follow up period [1]. Histological characteristics of PCa in radical prostatectomy (RP) specimens as Microvascular Invasion in Prostate Cancer pathological stage, final Gleason score, seminal vesicle involvement, surgical margin status, level of extraprostatic extension and tumor volume are frequently used to predict progression after surgery [2].
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