Lymphovascular invasion as a predictor of disease progression in prostate cancer

The biologic heterogeneity of prostate cancer (PCa) is evident from the large discrepancy between incidence rates and disease progression and tumor-related deaths. One of the challenges in treating patients with PCa lies in developing nomograms to identify patients who might benefit from adjuvant therapies. Lymphovascular invasion (LVI) is among the variables in PCa recommended to be reported by the Cancer Committee of the College of American Pathologists (CAP), yet few studies have evaluated the prognostic significance and prevalence of LVI in PCa. In the present study, whole-mount specimens from 263 patients with pT3N0 PCa treated by radical prostatectomy by a single surgeon were evaluated for the presence, location, and number of foci of LVI. Foci of LVI were identified in 91 patients. In cases with LVI the number of foci ranged from 1 to 40 with the majority of patients having 1 or 2 foci. LVI was found to be a significant predictor of disease progression in univariate analysis (p <0.0001) and was significantly related to Gleason sum (p <0.001), extra prostatic extension (focal vs established; p = 0.033), and seminal vesicle involvement (p <0.001). Furthermore, in multivariate analysis, LVI was a significant independent predictor of disease progression as well (p = 0.0014). These findings support the CAP recommendations and provide merit for the inclusion of LVI in nomograms to predict disease recurrence in PCa.