Is microvascular invasion on radical prostatectomy specimens a useful predictor of PSA recurrence for prostate cancer patients?

Objective: Angiogenesis is believed to play an important role in tumor prog ression and metastasis. The goal of this study was to investigate the clini cal utility of vascular invasion in prostate cancer patients treated by rad ical prostatectomy as a predictor of PSA recurrence. Methods: Between 1993 and 1998, 241 patients underwent radical prostatectom y at our institution and had routine analysis of vascular and/or lymphatic invasion (V/LI). V/LI was correlated with preoperative parameters including digital rectal examination (DRE), Gleason score (GS) on biopsy and serum P SA, with the pathological findings and with biochemical recurrence. Results: V/LI incidence was 12.4% (30 of 241 patients). Of the 30 patients with V/LI, 28 (93%) had GS greater than or equal to 7 (67%) had a pT3 disea se and 7 had SV invasion (23%). V/LI was not associated with DRE and GS on prostate needle biopsy. However, V/LI was correlated with the worst patholo gical findings including pT3 disease, seminal invasion, positive surgical m argins and GS on prostate specimen > = 7. Biochemical recurrence-free survi val was 92.5% for the patients with out V/LI as compared to 30.1% for patie nts with V/LI on prostate specimen examination (p = 0.0001). Multivariate a nalysis showed that preoperative serum PSA, Stage and V/LI were independent predictors of PSA recurrence. Patients with pT2 disease without V/LI had a biochemical recurrence-free survival of 99 vs. 31% in patients with V/LI ( p = 0.0001). Conclusion: This study demonstrated that V/LI is strongly associated with b iochemical recurrence after radical prostatectomy. The routine analysis of V/LI should be considered as a routine evaluation of the radical prostatect omy specimen. Copyright (C) 2000 S. Karger AG, Basel.