I'm researching the prognostic implications of LVI - any thoughts on the subject?
I've been reading a lot of nasty stuff about LVI as a strong indicator of PSA failure and DM. It appears not all agree as to it's prognostic role other than it's a negative pathological finding. Some failure rates cited are quite high - has anyone seen monograms that use LVI?
LVI does apparently provide a potential pathway for distant mets. I had 4 or 5 lymph nodes removed (all negative) but cancer could have taken residence in more distant locations. I guess the 10 dollar question is has the cancer spread beyond the local area (micromets?). If that's occurred then it's obviously a game changer.
There are some contra studies but they appear to be in the minority
Recently, the incidence of lymphovascular invasion in prostate cancer patients with pT3aN0 disease was found to range between 28% and 35%.13, 20 On univariate analysis, lymphovascular invasion was associated with a higher bpreoperative PSA and Gleason score in the prostatectomy specimen, but not with surgical margin status, biopsy Gleason score or clinical stage. In a multivariate analysis, preoperative PSA and lymphovascular invasion were identified as the only significant and independent predictors of PSA failure. When pT3aN0 prostate cancer patients were followed up without any treatment after radical prostatectomy, lymphovascular invasion was a significant and independent predictor of PSA failure and cancer progression. The 5-year PSA failure-free survival rate in patients with no lymphovascular invasion and PSA ≤10 ng/ml could be as high as 93.5%, suggesting that adjuvant therapy would not be indicated for this subset of patients. On the other hand, pT3aN0. patients with lymphovascular invasion had a poor prognosis, even when preoperative PSA was <10 ng/ml. In the study by May et al15 on node-negative prostate cancer patients treated by radical prostatectomy, lymphovascular invasion and Gleason score were independent predictors of biochemical failure, by multivariate analysis. The 5-year biochemical-free survival was 87.3% and 38.3% for patients without and with evidence of lymphovascular invasion in the radical prostatectomy specimen, respectively (P<0.001).