Microvessel density in prostate cancer: prognostic and therapeutic utility

Microvessel density is a promising prognostic factor in management of patients with prostate cancer. Unlike cancer cell-based factors, microvessel density is a host stromal factor that has apparently limited heterogeneity within a cancer. Its predictive value for pathological stage has been demonstrated in most but not all reports. Further, recent studies reveal that microvessel density may be predictive of cancer recurrence and perhaps survival in some patients. Inhibition of angiogenesis may be an effective chemopreventive approach, particularly for men at high risk of prostate cancer. The patient described in the case study may benefit from microvessel density determination. Manual or computer-assisted counting of microvessels in the diagnostic needle biopsy specimen would provide a value that could be compared with published findings to predict pathological stage and outcome, particularly in combination with Gleason score and serum prostate-specific antigen concentration. The probability of extraprostatic extension may be sufficiently high that a urologist may choose not to operate on the patient. Similarly, the probability of recurrence after surgery or radiation may be sufficiently high to warrant adjuvant therapy.