Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?
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.
Loeb
Stacy
S
James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. stacyloeb@gmail.com
Epstein
Jonathan I
JI
Humphreys
Elizabeth B
EB
Walsh
Patrick C
PC
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
D017430:Prostate-Specific Antigen
J Natl Cancer Inst. 1998 May 20;90(10):766-71
9605647
Cancer. 2007 Jan 1;109(1):13-24
17123267
Urology. 2007 Jul;70(1):111-6
17656219
Urology. 1999 Apr;53(4):752-6
10197851
Cancer Res. 2004 Sep 1;64(17):6082-90
15342391
J Urol. 2005 Feb;173(2):450-3
15643200
J Urol. 2001 Jan;165(1):126-9
11125380
J Urol. 2003 Feb;169(2):517-23
12544300
J Urol. 2005 Jun;173(6):1938-42
15879786
Am J Surg Pathol. 1993 Apr;17(4):336-41
8494103
Prostate Cancer Prostatic Dis. 2009;12(2):204-8
19238170
J Urol. 1999 Jul;162(1):103-6
10379750
Urology. 2005 Nov;66(5):1048-53
16286122
Am J Surg Pathol. 2004 Jul;28(7):946-52
15223967
Cancer. 1997 Jan 1;79(1):75-80
8988729
JAMA. 1998 Sep 16;280(11):969-74
9749478
Urology. 2002 Jan;59(1):85-90
11796287
Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1059-64
17398032
Am J Surg Pathol. 1980 Apr;4(2):143-8
6155085