Elsevier

Urology

Volume 51, Issue 1, January 1998, Pages 79-85
Urology

Adult Urology
Prediction of Patient Outcome in Pathologic Stage T2 Adenocarcinoma of the Prostate: Lack of Significance for Microvessel Density Analysis

https://doi.org/10.1016/S0090-4295(97)00464-0Get rights and content

Abstract

Objectives. Some patients with palpable intermediate- and high-grade, margin-free, organ-confined prostate cancer experience recurrence following prostatectomy. We studied the ability of microvessel density and other factors to predict recurrence in such patients with pathologic Stage T2 cancer.

Methods. Between 1987 and 1991, 307 patients underwent radical prostatectomy for Gleason score 6 to 9, margin-free, organ-confined prostate cancer at Mayo Clinic, Rochester, Minnesota. Specimens from 147 patients with sufficient cancer tissue for immunohistochemical staining with Factor VIII-related antigen were studied by computer-assisted digital image analysis for optimized microvessel density (OMVD). The correlation of deoxyribonucleic acid (DNA) ploidy, Gleason score, OMVD, unilateral disease, bilateral disease, and preoperative prostate-specific antigen (PSA) to cancer recurrence was assessed using the Cox model. Biochemical recurrence was defined as postoperative increase in PSA of greater than 0.2 ng/mL, and clinical recurrence was defined as positive biopsy or metastasis on bone scan.

Results. Mean follow-up for all patients was 6.1 years, with 12 deaths (1 due to prostate cancer) and 58 cases of clinical and/or biochemical recurrence. OMVD was not significantly associated with DNA ploidy, Gleason grade, unilateral disease, bilateral disease, or preoperative PSA. Preoperative PSA was the strongest predictor of clinical and/or biochemical recurrence in both univariate and multivariate analysis. OMVD was not a significant univariate or multivariate predictor of clinical and/or biochemical recurrence. The estimated relative risk of clinical and biochemical recurrence associated with a change in OMVD from the 25th percentile (OMVD 45) to the 75th percentile (OMVD 84) was 1.08 (95% confidence interval 0.79 to 1.47).

Conclusions. Preoperative PSA was the strongest predictor of clinical and/or biochemical recurrence of prostate cancer in this group of patients. Optimized microvessel density did not predict outcome in a select cohort of patients with palpable intermediate- and high-grade, margin-free, organ-confined prostate cancer (TNM stage T2N0M0).

Section snippets

Patients

The study cohort was selected from a group of 904 patients with margin-free pathologic Stage T2 prostate cancer previously reported by Lerner et al.[4]Patients with Gleason scores of 5 and less were excluded due to low recurrence rates in the follow-up interval (data not shown), resulting in 331 potential patients. Twenty patients with clinical T1 disease as well as 3 patients restaged as pathologic Stage T3 were excluded, leaving 308 patients with palpable margin-free organ-confined prostate

Patient Characteristics

Clinical and pathologic findings for study patients were compiled following prostatectomy (Table I). The mean age at prostatectomy was 67.5 years (range 50 to 81). Median preoperative PSA was 8.4 ng/mL (range 0.08 to 76.6). Mean (median) follow-up for all patients was 6.1 (6.6) years. At the close of the study, 12 patients were dead (one of prostate cancer).

When clinical and pathologic findings of study patients were compared to the 161 patients excluded for insufficient prostatectomy

Comment

Cancer recurrence in patients with palpable organ-confined margin-negative prostate cancer after prostatectomy remains incompletely understood.1, 2, 3, 4Prediction of patients at highest risk would be valuable in considering adjuvant treatment. We evaluated OMVD, Gleason grade, preoperative PSA, and DNA ploidy as predictors of cancer recurrence in these patients. OMVD for all patients was not predictive of biochemical or clinical recurrence within the mean 6.1 years of follow-up. Conversely,

Conclusions

We found that preoperative PSA was the most significant predictor of recurrence in patients with palpable intermediate- and high-grade margin-free pathologic Stage T2 adenocarcinoma of the prostate. In our narrow study population, Gleason grade tended toward significance in predicting cancer recurrence. Optimized microvessel density was not predictive of biochemical or clinical recurrence in this group of patients.

Acknowledgements

Acknowledgment.

To Jeff M. Slezak, B.S., for statistical analysis and programming support.

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