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Posted 7/30/2011 11:07 PM (GMT 0)
Hi everyone,
Any significance to 'lymphovascular invasion identified' on surgical pathology report following radical prostatectomy?

Ken
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Age 54
PSA 5.7, DRE RT firm
Biopsy results 6/1/11
GS8 (4+4) 2 of 12 cores
CT & Bone scan negative
Robot assisted RP 7/21/11, cath removed 7/29/11
 
Surgical pathology carcinoma summary:
Site:  bilateral
Gleason score:  4+4
Margin status:  negative
Seminal vesicle invasion:  not identified
Extraprostatic extension:  identified, bilateral
Lymphovascular incision:  identified
Large venous invasion:  not identified
Lymph node status:  RT 0/4 negative, LT 0/3 negative
TNM stage:  pT3a pN0
Posted 7/30/2011 11:46 PM (GMT 0)
From a breast cancer site, but the description is valid for abdominal lymph nodes:

What is lymphovascular invasion? How does it differ from having positive nodes? And how does it affect my treatment choices?

When a pathologist examines tissue removed during a lumpectomy or mastectomy, one of the things she looks to see is whether cancer cells are present in any of the blood vessels or lymphatic vessels. If they are, it is referred to as vascular invasion, lymphatic invasion, or lymphovascular invasion (LVI).

A woman can have lymphovascular invasion but not have positive lymph nodes. This could be because the invasion hasn't spread to the lymph nodes or because it has bypassed the nodes and moved on to other areas of the body.

When LVI is present, doctors assume this means that the cancer has acquired the genetic mutation it needs to create its own blood vessels, a process called angiogenesis. Because a tumor that has the ability to create its own blood vessels may have already begun to spread cancer cells to other parts of the body, the presence of LVI is an indicator that treatment should most likely include chemotherapy or hormone therapy (if the tumor is hormone sensitive).


www.dslrf.org/breastcancer/content.asp?CATid=28&L2=1&L3=6&L4=0&Pid=&sid=132&cid=1104

Hope this helps explain it. The last sentence needs to be discussed with your doc.
Posted 7/31/2011 12:34 AM (GMT 0)
Hi Ken

My Path report included Lymohovascular invasion. My LN's were also clear. See my post "Robotic Surgery". I received some good information from some of the guys.

Posted 7/31/2011 1:36 AM (GMT 0)
Hi Ken, - Yes, it MAY have some significance. Generally speaking, some studies have shown that LVI increases the statistical possibility of recurrence and decreased the effectiveness of salvage Radiation. If you will E-mail me, I will E-mail back you some abstracts regarding the subject, and you can make your own interpretation. [email protected] (aka) az4peaks.
Posted 8/2/2011 12:20 AM (GMT 0)
As I understand it,

LVI indicates the cancer has acheived an intital step necessary for metastasis - but there are still many more required steps for sucessful metastasis - my radiation oncologist said there were roughly 40 steps necessary for prostate cancer metastasis. Accordingly, it is a negaitive prognostic indicator and should be routinely reported in pathology reports when present.

However, LVI is frequently accompanied by other well established negative factors i.e., high pre-op PSA, high G-score, positive margins etc. which are commonly used in monograms. Due to the lack of consensus regarding LVI's contribution to overall risk it appears to not to be used in most monograms (I've seen one). The degree of prognostic value of LVI above and beyond existing well established risk factors is not agree upon within the medical PC community.

Currently, many of the studies are based on a small sample sizes and more study is needed to quantify LVI's contribution to risk. Developing meaningfull statistically models with prognostic value requires larger sample sizes and controls for all the other various negaive factors often present with LVI.

If you believe the article cited below then current monograms tell most of the risk story already.

http://www.sciencedirect.com/science/article/pii/S0090429506002214

Urology - Volume 68, Issue 1, July 2006, Pages 99-103

"LVI is found in fewer than 10% of radical prostatectomy specimens for clinically localized disease. It is seen almost exclusively in high-volume tumors in conjunction with other adverse pathologic features. On univariate analysis, LVI was significantly associated with biochemical progression, but not with a preoperative PSAV greater than 2 ng/mL/yr. When combined with all other clinical and pathologic features in a multivariate model, LVI lost its independent prognostic significance. Thus, although the finding of LVI on a pathology report is certainly an adverse prognostic feature, it appears that its effect on the biochemical progression rate is mediated through its strong association with other adverse pathologic features."

K2

Posted 8/2/2011 6:21 PM (GMT 0)
Thanks for everyone's response. Seems that LVI is associated with more aggressive cancer but the stats don't indicate much significance and that there are more significant measures for recurrence risk. K2 seemed to sum up LVI the best. My uro didn't seem too concerned in that we already intend to watch my PCa closely, no more closer with LVI.

Ken
Age 54
PSA 5.7, DRE RT firm
Biopsy results 6/1/11
GS8 (4+4) 2 of 12 cores
CT & Bone scan negative
Robot assisted RP NS 7/21/11, Stanford University/Gonzalgo
 
Surgical pathology carcinoma summary:
Site:  bilateral
Gleason score:  4+4
Margin status:  negative
Seminal vesicle invasion:  not identified
Extraprostatic extension:  identified, bilateral
Lymphovascular incision:  identified
Large venous invasion:  not identified
Lymph node status:  RT 0/4 negative, LT 0/3 negative
TNM stage:  pT3a pN0
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