OPTIMIZED MICROVESSEL DENSITY ANALYSIS IMPROVES PREDICTION OF CANCER STAGE FROM PROSTATE NEEDLE BIOPSIES

Objectives. Clinical staging of prostate cancer is inaccurate, often w ith significant upstaging on final pathologic review. We previously de monstrated the ability to predict extraprostatic extension of cancer b y use of the Gleason score and serum prostate-specific antigen (PSA) m easurements. Herein we present an interim analysis of data from an ong oing multi-institutional study to determine the predictive power of an enhancement of microvessel density analysis in combination with Gleas on score and serum PSA to predict extraprostatic extension. Methods. W e evaluated a total of 186 randomly selected needle biopsy samples and matched totally embedded radical prostatectomy samples with preoperat ive PSA concentrations and patient demographics. Gleason score and opt imized microvessel density (OMVD) were determined from the needle biop sy samples; pathologic stage was verified by independent review of the radical prostatectomy samples. An automated digital image analysis sy stem measured microvessel morphology and calculated the OMVD in the bi opsy samples (Biostage; Bard Diagnostic Sciences, Seattle, Wash). Resu lts. Prediction of extraprostatic extension was increased significantl y when OMVD analysis was added to Gleason score and serum PSA concentr ation (P = 0.003). Conclusions. Optimized microvessel density analysis significantly increases the ability to predict extraprostatic extensi on of cancer preoperatively when combined with Gleason score and serum PSA concentration. This method appears to be a useful tool that can a ssist with treatment decisions in selected patients.