Prostate cancer: Relationship between vascular diameter, shape and density and Gleason score in needle biopsy specimens


Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Tumor growth requires expansion and development of vascular network. An increase in Gleason score is representative of an increase in tumor invasion and extent. In this study, the relationship between Gleason score and vascular characteristics of needle biopsy samples in prostate cancer patients has been evaluated.
Materials and Methods: We evaluated vascular characteristics including density and size of vessels; and percentage of vessels with irregular shape in 62 cancer-positive samples obtained by prostate needle biopsy under ultrasound guide, and compared them to Gleason score.
Result: Gleason scores of 23 patients were ≤6; Gleason scores of 18 patients were 7 and 21 patients had their Gleason score from 8 to 10. An increase in Gleason score was associated with increased vascular density (P < 0.0001), increased percentage of vessels with irregular shape (P < 0.02) and decreased average vascular diameter (P < 0.015), from which the relationship with vascular density was clearer and more evident.
Conclusion: Vascular morphological characteristics can be representative of angiogenic potential of prostate cancer which is required for tumor progression. As Gleason score can prognosticate the behavioral characteristics of prostate cancer in future, vascular characteristics may also be able to express tumor behavior. With attention to vascular characteristics in biopsy samples and apart from Gleason score, we may also be able to divide patients into other subtypes in a way being helpful for the establishment of treatment plan.


1. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005;293:2095-101  Back to cited text no. 1
2. Johansson JE, Andrén O, Andersson SO, Dickman PW, Holmberg L, Magnuson A, et al. Natural history of early, localized prostate cancer. JAMA 2004; 291:2713-9.  Back to cited text no. 2
3. Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352:1977-84.  Back to cited text no. 3
4. Porter CR, Kodama K, Gibbons RP, Correa R Jr, Chun FK, Perrotte P, et al. 25-year prostate cancer control and survival outcomes: A 40-year radical prostatectomy single institution series. J Urol 2006; 176:569-74.  Back to cited text no. 4
5. William J Catalona, Misop Han. Defnitive Therapy for localized prostate cancer: An overview. In: Alan J Wein, editor. Campbell-Walsh Urology. New York: McGraw-Hill; 2012. p. 2772-85.  Back to cited text no. 5
6. Folkman J. Angiogenesis in cancer, vascular, rheumatoid and other disease. Philadelphia, PA: Lippincott; 1997: 3075-3085.  Back to cited text no. 6
7. Fukumura D, Jain RK. Tumor microvasculature and microenvironment: Targets for anti-angiogenesis and normalization. Microvasc Res 2007; 74:72-84.  Back to cited text no. 7
8. Folkman J: Tumor angiogenesis: Therapeutic implications. N Engl J Med 1971; 285:1182-6.  Back to cited text no. 8
9. Hanahan D, Folkman J. Patterns and emerging mechanisms of the angiogenic switch during tumorigenesis. Cell 1996; 86:353-64.  Back to cited text no. 9
10. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis: Correlation in invasive breast carcinoma. N Engl J Med 1991; 324:1-8.  Back to cited text no. 10
11. Weidner N, Carroll PR, Flax J, Blumenfeld W, Folkman J. Tumor angiogenesis correlates with metastasis in invasive prostate carcinoma. Am J Pathol 1993; 143:401-9.  Back to cited text no. 11
12. Borre M, Offersen BV, Nerstrøm B, Overgaard J. Microvessel density predicts survival in prostate cancer patients subjected to watchful waiting. Br J Cancer 1998; 78:940-4.  Back to cited text no. 12
13. Silberman MA, Partin AW, Veltri RW, Epstein JI. Tumor angiogenesis correlates with progression after radical prostatectomy but not with pathologic stage in Gleason sum 5 to 7 adenocarcinoma of the prostate. Cancer 1997; 79:772-9.  Back to cited text no. 13
14. Albertsen PC, Hanley JA, Barrows GH, Penson DF, Kowalczyk PD, Sanders MM, et al. Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst 2005; 97:1248-53.  Back to cited text no. 14
15. Mucci LA, Powolny A, Giovannucci E, Liao Z, Kenfield SA, Shen R, et al. Prospective study of prostate tumor angiogenesis and cancer-specific mortality in the health professionals follow-up study. J Clin Oncol 2009; 27:5627-33.  Back to cited text no. 15
16. Vaupel P, Kallinowski F, Okunieff P. Blood flow, oxygen and nutrient supply, and metabolic microenvironment of human tumors: A review. Cancer Res. 1989; 49: 6449-65.  Back to cited text no. 16
17. Jain RK. Normalization of tumor vasculature: An emerging concept in antiangiogenic therapy. Science 2005; 307:58-62.  Back to cited text no. 17