Prognostic significance of lymphovascular invasion in assessing metastatic potential in prostate cancer

Abstract

Introduction. Prostate cancer (PC) is one of the most common malignant neoplasms in the male population and exhibits marked biological heterogeneity, ranging from indolent forms to aggressive variants characterised by an invasive tumour phenotype and increased metastatic potential. In this context, the identification of histopathological markers with prognostic value is essential. Lymphovascular invasion (LVI) is considered an important morphological parameter, as it has been associated with an increased risk of tumour progression and disease recurrence. Materials and Methods. The study included 70 patients diagnosed with acinar adenocarcinoma of the prostate, who were investigated at the IMSP Institute of Oncology between 2022 and 2025. The mean age of the patients was 67 ± 6.8 years (median: 68 years). Histopathological evaluation was performed on haematoxylin–eosin (H&E)-stained sections. Statistical analysis included the calculation of the mean and median, as well as Spearman’s correlation analysis, with the threshold for statistical significance set at p < 0.05. Results. The presence of lymphovascular invasion was histopathologically confirmed in 25 patients (35.7%). Correlation analysis revealed statistically significant positive associations between LVI and perineural invasion (rₛ = 0.21, p = 0.04). In addition, the incidence of LVI increased proportionally with pathological pTNM staging (rₛ = 0.27, p = 0.01) and total Gleason score (rₛ = 0.54, p = 0.001). Significant correlations were identified between LVI and the presence of lymph node metastases on both the right side (rₛ = 0.42, p = 0.001) and the left side (rₛ = 0.52, p = 0.001). At the nodal level, LVI showed a significant correlation with the presence of hyalinosis (rₛ = 0.49, p = 0.001). In contrast, chronic prostatitis did not demonstrate a statistically significant association with LVI (rₛ = 0.13, p = 0.14). Furthermore, no significant correlations were observed between LVI and patient age, number of involved lobes, prostatic capsular invasion, lymphocytic infiltrate, cellular atypia, lipid degeneration, or sinus histiocytosis (p > 0.05). Conclusions. Lymphovascular invasion, observed in more than one-third of the patients included in this study, constitutes a histopathological marker linked to an aggressive tumour phenotype in prostate cancer. Statistically significant associations with perineural infiltration, advanced pathological stage, elevated Gleason scores and bilateral lymph node involvement reinforce its prognostic relevance. Moreover, the relationship with nodal stromal changes, including hyalinosis, indicates a possible role of lymphovascular invasion in the processes governing metastatic spread. Accordingly, this parameter may serve as a meaningful indicator of metastatic propensity and tumour biological severity, with practical implications for risk stratification and clinical decision-making in prostate cancer management.