title: Predicting the risk of non-organ-confined prostate cancer when perineural invasion is found on biopsy.
abstract: OBJECTIVE
  To more precisely define the risk of non-organ-confined (non-OC) prostate cancer among men with perineural invasion (PNI) identified on prostate biopsy.
  
  
  METHODS
  The Johns Hopkins radical prostatectomy database was queried for men with PNI reported on prostate biopsy. Patients with and without non-OC disease were compared for differences in preoperative clinical and pathologic characteristics, including three biopsy-based measures of tumor volume (number of cores with cancer, percentage of cores with cancer, and maximum percent core involvement with cancer). After evaluating the different preoperative variables in univariate analyses, a multivariable logistic regression model was generated, and bootstrap estimates of the risk of non-OC disease were calculated.
  
  
  RESULTS
  In total, 556 patients with PNI were analyzed, 279 (50.2%) of whom were found to have non-OC prostate cancer. In univariate analyses, preoperative prostate-specific antigen, clinical T stage, biopsy Gleason sum, and the three biopsy-based measures of tumor volume were significantly associated with non-OC disease. Of the three measures of tumor volume, the best fit to the data and highest degree of model discrimination were obtained using maximum percent core involvement with cancer. Incorporating this variable, preoperative prostate-specific antigen, clinical T stage, and biopsy Gleason sum into a multivariable model, the estimated risk of non-OC disease was found to range from 13.8% to 94.4% (bootstrap corrected c-index = 0.735).
  
  
  CONCLUSIONS
  Men with PNI on prostate biopsy are at a wide range of risk for non-OC disease. Preoperative estimation of this risk is improved by considering readily available biopsy estimates of tumor volume.
authors.affiliation: The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: mgorin1@jhmi.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.affiliation: The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Chalfin
authors.affiliation: Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Zhaoyong
authors.initials: Z
authors.lastname: Feng
authors.affiliation: The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.affiliation: The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011467:Prostate / Q000294:innervation / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment