PATHOLOGY

Vascular invasion is an independent prognostic factor in prostatic adenocarcinoma
Carr MD, Koch MO, Eble JN, Zeng G, Daggy J, Cheng L
Indiana University School of Medicine, Indianapolis, Indiana, USA
Mod Pathol. 2004; 17 (suppl.1): 144A

• Background: Prostate cancer is a significant cause of cancer morbidity and mortality in North American men. Tumor grade and stage are well-accepted prognostic factors. Histologic demonstration of tumor in vascular spaces has been associated with poor prognosis in many tumor types. Whether vascular invasion represents an independent prognostic factor for disease progression is uncertain in prostate cancer.
• Design: 504 cases of prostatic adenocarcinoma from patients undergoing radical prostatectomy were reviewed for the presence of vascular invasion. Clinical followup data was available for 459 cases.
• Results: Vascular invasion was identified in 106 (21%) of the cases. Univariate analysis showed a significant association between vascular invasion and PSA recurrence, tumor stage, Gleason grade, extraprostatic extension, seminal vesicle invasion, lymph node metastasis, surgical margins, perineural invasion, and preoperative serum PSA level (all p < 0.001). No association was observed between vascular invasion and age at surgery, prostate weight, or the presence of high grade prostatic intraepithelial neoplasia. Vascular invasion is an independent predictor of PSA recurrence after controlling for tumor stage and Gleason grade in the multivariate analysis.
• Conclusions: Vascular invasion can be seen in approximately 20% of prostate cancers. Vascular invasion is an independent risk factor for PSA recurrence.
  
  
• Editorial Comment
  This paper emphasizes the importance of vascular invasion in radical prostatectomies. Most of the pathologists do not report this finding because it does not alter staging of the tumor. The same occurs in kidney and urinary bladder tumors except in testicular neoplasias. Since the 1997 edition of the TNM system for classification of malignant tumors, testicular neoplasms limited to the testis but with vascular invasion are classified as pT2 tumors.
  The study from the Indiana University showed that vascular invasion seen in approximately 20% of prostate cancers is an independent predictor of PSA recurrence after controlling for tumor stage and Gleason grade in the multivariate analysis. It was shown that vascular invasion is important and should be reported by pathologists. We hope that this finding is confirmed by other studies and considered in future staging systems.

Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil