Korean J Urol.  2015 Jun;56(6):435-442. 10.4111/kju.2015.56.6.435.

Two-dimensional neovascular complexity is significantly higher in nontumor prostate tissue than in low-risk prostate cancer

• Taverna G
• Grizzi F
• Colombo P
• Seveso M
• Giusti G
• Proietti S
• Fiorini G
• Lughezzani G
• Casale P
• Buffi N
• Lazzari M
• Guazzoni G

• KMID: 2160583
• DOI: http://doi.org/10.4111/kju.2015.56.6.435

Abstract

PURPOSE
Prostate cancer is the most frequent cancer in men in Europe. A major focus in urology is the identification of new biomarkers with improved accuracy in patients with low-risk prostate cancer. Here, we evaluated two-dimensional neovascular complexity in prostate tumor and nontumor biopsy cores by use of a computer-aided image analysis system and assessed the correlations between the results and selected clinical and pathological parameters of prostate carcinoma.
MATERIALS AND METHODS
A total of 280 prostate biopsy sections from a homogeneous series of 70 patients with low-risk prostate cancer (Gleason score 3+3, prostate-specific antigen [PSA]<10 ng/mL, and clinical stage T1c) who underwent systematic biopsy sampling and subsequent radical prostatectomy were analyzed. For each biopsy, 2-microm sections were treated with CD34 antibodies and were digitized by using an image analysis system that automatically estimates the surface fractal dimension.
RESULTS
Our results showed that biopsy sections without cancer were significantly more vascularized than were tumors. No correlations were found between the vascular surface fractal dimension and patient's age, PSA and free-to-total PSA ratios, pathological stage, Gleason score, tumor volume, vascular invasion, capsular penetration, surgical margins, and biochemical recurrence.
CONCLUSIONS
The value of angiogenesis in prostate cancer is still controversial. Our findings suggest that low-risk prostate cancer tissues are less vascularized than are nontumor tissues. Further studies are necessary to understand whether angiogenesis is a hallmark of intermediate- and high-risk prostate cancer.

Keyword

Biological markers; Blood vessels; Neoplasms; Prostate

MeSH Terms

Adult
Aged
Biopsy, Needle
Fractals
Humans
Image Processing, Computer-Assisted/methods
Kallikreins/blood
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Neovascularization, Pathologic/*pathology
Prostate/*blood supply
Prostate-Specific Antigen/blood
Prostatectomy
Prostatic Neoplasms/*blood supply/pathology/surgery
Retrospective Studies
Kallikreins
Prostate-Specific Antigen

Figure

• 

  Fig. 1 (A) The surface fractal dimension, as a numerical index of the two-dimensional geometrical complexity of tumor vascular networks, in patients with prostate cancer. Statistically significant differences were found between the surface fractal dimension in tumor biopsy (TB) samples versus nontumoral biopsy (NTB) cores. The same difference is found when the population is divided in two groups according to the pathological Gleason grade 3+3 or 3+4 at the subsequent radical prostatectomy (B and C, respectively). *p<0.01. ***p<0.0001. ****p<0.00001.

• 

  Fig. 2 Multilevel-based procedure for estimating the two-dimensional vascular fractal dimension in tumor and nontumor biopsy cores. It has been recognized that two main issues influence results in the quantification of microvascularity in prostate tissue: (1) subjectivity in the diagnostic interpretation and (2) inadequate quantitative parameter. The present procedure automatically identified the microvascularity and estimated the surface fractal dimension as an index of the geometrical microvascular complexity.

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