Prostate cancer (PC) is the second most frequent cause of male cancer related death. Over the past decade there have been various methods used to determine prognosis of patients with PC; this includes a combination of clinical staging, Gleason score, and serum levels of PSA (prostate specific antigen) [1]. The classification of PC into Gleason score is based on the evaluation of the degree of glandular differentiation and architectural pattern, but correlation of tumor neovascularity with progression of disease has not been taken into consideration [1]. Studies have shown that angiogenesis, particularly microvessel density (MVD), plays and important role in prognosis and is a therapy target in various malignancies (breast, colon, cervix, melanoma), but its significance in prostate cancer is controversial [2]. Studies have shown a correlation between tumor grade, stage, progression, and survival with increased angiogenesis in PC, however further studies are contradictory about the role of MVD as an independent prognostic value and its role in prostatic carcinogenesis [2], [3]. Nonetheless, this is relevant to the more than 20 angiogenesis inhibitor clinical trials currently underway using angiogenesis-targeting strategies in PC [4].

Despite the conflicting results surrounding this subject [1], [2], [3], [4] the changes to the prostatic native vessels have not been studied since 2000 when Garcia et al. demonstrated for the first time that within PC, the walls of native arteries have marked media hypercellularity and increased artery thickness. This study demonstrated a possible remodeling of native vessels with progression of disease and demonstrated a correlation with pathologic stage [5]. However, Garcia et al. had only used traditional stereological techniques without the accuracy digital analysis provides. Our study is the first to use digital technology with the use of virtual slides to study prostatic native vessels, precisely annotated by pathologists, to analyze digitally media thickness, cellularity, and media to lumen ratio.