Prostate Prognostication

Blood-vessel viewing may predict tumor behavior

Steven ClintonA prostate cancer diagnosis raises an important question for physicians and their patients: Will the tumor grow quickly, requiring continuous treatment, or slowly, allowing therapy and its risks to be safely delayed?

The answer may lie in the size and shape of blood vessels within the tumor, according to research led by The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James) in collaboration with the Harvard School of Public Health.

A study of 572 men with localized prostate cancer indicates that aggressive tumors tend to have blood vessels that are small, irregular and primitive in cross-section, while vessels in indolent tumors look more normal.

“It’s as if aggressive prostate cancers grow faster, and their blood vessels never fully mature,” says study leader Steven Clinton, MD, PhD, a prostate cancer specialist and researcher at the OSUCCC – James. “Prostate cancer is heterogeneous, and we need better tools to predict whether a patient has a form that is aggressive, fairly average or indolent so we can better define a course of treatment – surgery, chemotherapy, radiotherapy, hormonal therapy, or potentially new drugs that target blood vessels – that is specific for each person’s type of cancer.”

After an average follow-up of 10 years, 44 of the 572 men in this study had developed metastatic cancer or died of their cancer. Men whose tumors had smaller vessel diameters were six times more likely to have aggressive tumors and die of their disease, and those with the most irregularly shaped vessels were 17 times more likely to develop lethal prostate cancer.

The findings, which were independent of Gleason score and prostate specific antigen (PSA) level, apply to men with local disease, whose PSA is only modestly elevated, and who are younger and more likely to choose surgery. “If our fi ndings are validated by larger studies, the measurement of tumor blood vessel architecture might help determine choice of therapy,” Clinton says.

Published Nov. 20, 2009, in the Journal of Clinical Oncology.

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