title: Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?
abstract: OBJECTIVE
  To determine the relationship between perineural invasion (PNI) on prostate biopsy and radical prostatectomy (RP) outcomes in a contemporary RP series, as there is conflicting evidence on the prognostic significance of PNI in prostate needle biopsy specimens.
  
  
  METHODS
  From 2002 to 2007, 1256 men had RP by one surgeon. Multivariable logistic regression and Cox proportional hazards models were used to examine the relationship of PNI with pathological tumour features and biochemical progression, respectively, after adjusting for prostate-specific antigen level, clinical stage and biopsy Gleason score. Additional Cox models were used to examine the relationship between nerve-sparing and biochemical progression among men with PNI.
  
  
  RESULTS
  PNI was found in 188 (15%) patients, and was significantly associated with aggressive pathology and biochemical progression. On multivariate analysis, PNI was significantly associated with extraprostatic extension and seminal vesicle invasion (P < 0.001). Biochemical progression occurred in 10.5% of patients with PNI, vs 3.5% of those without PNI (unadjusted hazard ratio 3.12, 95% confidence interval 1.77-5.52, P < 0.001). However, PNI was not a significant independent predictor of biochemical progression on multivariate analysis. Finally, nerve-sparing did not adversely affect biochemical progression even among men with PNI.
  
  
  CONCLUSIONS
  PNI is an independent risk factor for aggressive pathology features and a non-independent risk factor for biochemical progression after RP. However, bilateral nerve-sparing surgery did not compromise the oncological outcomes for patients with PNI on biopsy.
authors.affiliation: James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. stacyloeb@gmail.com
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Humphreys
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D010502:Perineum / Q000473:pathology; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
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