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 invasi on in prostate cancer patients treated by radical prostatectomy for cl inically localized and locally advanced disease. Materials and Methods : Vascular invasion was determined during a routine work-up of radical prostatectomy specimens of 273 patients who underwent surgery for pro static carcinoma. The correlation with other pathological variables wa s investigated. The prognostic influence for clinical progression, loc al recurrence, distant metastases, biochemical progression, overall su rvival and cancer-specific survival was determined. Results: Vascular invasion was present in 33 patients (12%). Vascular invasion correlate d significantly with capsular perforation, seminal vesicle invasion, p ositive margins of resection, perineural invasion, high grade, and pat hological stage. Vascular invasion was a significant prognostic factor for clinical progression (p < 0.001), local recurrence (p = 0.007), d istant metastases (p < 0.001), biochemical progression (p < 0.001), ov erall survival (p = 0.02), and cancer-specific survival (p < 0.001). M ultivariate analysis, adjusting for capsular perforation, high grade, and positive margins of resection, showed that vascular invasion was a ssociated with a 2.5-fold increased risk for clinical progression. Thi s relative risk was 2.3 for biochemical progression, and 2.7 for cance r-specific survival. Conclusion: Vascular invasion is a very important pathological variable for progression and survival, and must be evalu ated on a routine basis during the work-up of radical prostatectomy sp ecimens.