Perineural invasion in prostate biopsy specimens is associated with increased bone metastasis in prostate cancer.
BACKGROUND
We aimed to evaluate the relationship between perineural invasion (PNI) and bone metastasis in prostate cancer (PCa).


METHODS
We retrospectively reviewed the data of 633 PCas who had whole-body bone scan (WBBS) between 2008 and 2014. We recorded the age, clinical T-stage, total PSA (tPSA) prior to biopsy, Gleason sum (GS), and PNI in transrectal ultrasound guided biopsy (TRUS-Bx) and digital rectal examination findings. Bone metastases were assessed with WBBS and magnetic resonance image if WBBS was suspicious. We divided the patients into two groups according to NCCN criteria: (Group 1) bone scan not indicated, (Group 2) bone scan indicated.


RESULTS
There were 262 patients in Group 1 and 371 in 2. There is not significant relationship between PNI and bone metastasis in Group 1. However, there is very limited number of metastatic patients (n = 12) in this group. There is a strong relationship between PNI and bone metastasis in Group 2 (P = 0.001). Sensitivity, specificity and positive predictive value of PNI for bone metastasis were 72.4%, 81.7%, and 77.7%, respectively. In this group, tPSA, GS, positive DRE, and PNI were significant covariates for prediction of bone metastasis in univariate and multivariate analysis (except age). The most powerful predictor was PNI, and it increased the risk of bone metastasis 11-fold.


CONCLUSIONS
PNI in the TRUS-Bx specimens is the most powerful predictive histopathological feature for bone metastasis, by increasing the risk of bone metastasis 11-fold in NCCN bone scan indicated patients (Group 2).
Department of Urology, Sivas Numune State Hospital, Sivas, Turkey.
Seyfettin
S
Ciftci
Department of Urology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Hasan
H
Yilmaz
Department of Nuclear Medicine, Sivas Cumhuriyet University Medical Faculty, Sivas, Turkey.
Esra
E
Ciftci
Department of Urology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Emrah
E
Simsek
Department of Urology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Murat
M
Ustuner
Department of Urology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Ufuk
U
Yavuz
Department of Pathology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Bahar
B
Muezzinoglu
Department of Urology, University of Kocaeli Medical Faculty, Kocaeli, Turkey.
Ozdal
O
Dillioglugil
D000368:Aged; D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary*; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
bone metastasis; perineural invasion; prostate biopsy; prostate cancer