Prediction of pathological stage and biochemical failure after radical prostatectomy utilizing optimized microvessel density analysis of preoperative prostate needle biopsies

Objectives: The authors examined the relationship of optimized microvessel density (OMVD) in preoperative prostate needle biopsies to pathological stage and biochemical failure after radical prostatectomy. Study Design: From July 1992 to April 1995, 26 consecutive men diagnosed with stage T2b prostate cancer who elected treatment with radical prostatectomy were evaluated. Seven patients had insufficient tissue remaining in the preoperative biopsy cores for analysis and were excluded from OMVD analysis. Optimized microvessel density determination utilizes computer-assisted image processing following staining of vascular endothelium with antibody to von Willebrand Factor. Preoperative prostate-specific antigen (PSA), needle biopsy Gleason score, radical prostatectomy Gleason score, percentage of grade 4 and grade 5 cancer on the biopsies, and OMVD on biopsies were analyzed for correlation with pathological stage and postoperative biochemical failure. Results: Mean follow-up was 70 months (range, 63-91 mo). Mean OMVD for patients with T2 and T3 disease was 61.6 (range, 26-145.7) and 55.8 (range, 26-91.7), respectively. Mean OMVD for patients with biochemical failure was 53.5 (range, 26-87.3), and for patients with undetectable postoperative PSA the OMVD was 62.3 (range, 26-145.7). OMVD did not correlate with pathological stage (P = 0.34) or biochemical recurrence (P = 0.26). Preoperative PSA, percentage of grade 4 and grade 5 cancer in preoperative biopsy cores, and radical prostatectomy Gleason score were found to correlate with future biochemical failure. Conclusions: Analysis of OMVD in prostate biopsies failed to correlate with pathological stage or future biochemical failure following radical prostatectomy. Preoperative PSA, percentage of grade 4 and grade 5 cancer on the biopsy core, and prostatectomy Gleason score were more useful prognostic factors associated with subsequent biochemical failure.