Role of microvessel density in predicting recurrence in pathologic Stage T3 prostatic adenocarcinoma

Objectives. Extraprostatic extension of prostatic adenocarcinoma (pathologi c Stage TS) increases the risk of recurrence after radical prostatectomy co mpared with organ-confined prostate cancer. Use of microvessel density in p redicting cancer recurrence in Stage pT3 cancer is poorly understood. We ev aluated known predictors of recurrence, including Gleason grade, preoperati ve serum prostate-specific antigen (PSA), DNA ploidy, seminal vesicle invol vement, and surgical margin status in comparison with optimized microvessel density (OMVD) and area-weighted microvessel density (AWMVD) in patients w ith Stage pT3 prostate cancer. Methods. Between 1987 and 1989, 290 previously untreated patients underwent radical prostatectomy and were found to have pathologic Stage T5 adenocarc inoma. No patient received adjuvant therapy. Embedded prostatectomy specime ns from 211 patients with sufficient tissue for immunohistochemical stainin g with factor VIII-related antigen were studied by computer-assisted digita l image analysis for OMVD and AWMVD. The correlation of Gleason grade, preo perative PSA, DNA ploidy, seminal vesicle involvement, surgical margin posi tivity, OMVD, and AWMVD with clinical or biochemical failure was assessed u sing the Cox proportional hazards model. Biochemical failure was defined as a postoperative increase in PSA greater than 0.2 ng/mL, and clinical failu re was defined as a positive biopsy or metastasis on bone scan. Results. The mean follow-up +/- SD for all patients was 7.1 +/- 1.8 years, with 43 deaths (9 due to prostate cancer) and 124 cases of clinical and/or biochemical recurrence. The mean OMVD was 65.0 +/- 17.3, and the mean AWMVD was 8.2 +/- 5.5. OMVD and AWMVD were not predictors of cancer recurrence o r significantly associated with DNA ploidy or preoperative PSA. AWMVD was a ssociated with Gleason grade (P = 0.003). The estimated relative risk (adju sted for other cancer variables) of clinical and biochemical recurrence ass ociated with a change in OMVD from the 25th percentile (53.5) to the 75th p ercentile (75.4) was 1.14 (95% confidence interval 0.92 to 1.42). The estim ated relative risk (adjusted) of clinical and biochemical recurrence associ ated with a change in AWMVD from the 25th percentile (4.8) to the 75th perc entile (10.4) was 1.17 (95% confidence interval 0.97 to 1.42). Gleason grad e, preoperative PSA, DNA ploidy, and seminal vesicle involvement were predi ctors of clinical and/or biochemical recurrence in univariate and multivari ate analyses. Conclusions. Microvessel density, assessed by OMVD and AWMVD, did not predi ct recurrence in patients with pathologic Stage T3 adenocarcinoma of the pr ostate (TNM Stage T3N0M0). DNA ploidy, Gleason grade, preoperative PSA, and seminal vesicle involvement remained the best predictors of clinical and/o r biochemical recurrence in this group of patients. (C) 1999, Elsevier Scie nce Inc.