title: Perineural invasion on biopsy is associated with upstaging at radical prostatectomy in Gleason score 3 + 4 = 7 prostate cancer.
abstract: This study assesses if perineural invasion (PNI) detected on biopsy with Gleason score (GS) 3 + 4 = 7 prostate cancer (PCa) is associated with upstaging/upgrading of disease after radical prostatectomy (RP). 154 patients with GS 3 + 4 = 7 PCa diagnosed from biopsy who underwent RP were assessed for PNI. The percentage of biopsy sites with PNI (%PNI) was also calculated. Pattern 4 morphologies (ill-defined glands [IDG], fused, cribriform, and glomerulations) were also assessed. Clinical information, GS and stage after RP were retrieved from the medical records. 45 % (69/154) of patients were upstaged (≥pT3) and 29 % (44/154) were upgraded to GS >3 + 4 = 7 after RP. 37 % (57/154) of patients had PNI which was associated with upstaging (RR 1.4; P = 0.04) but not upgrading (RR 0.9; P = 0.7). There was higher %PNI in upstaged patients (12.1 % ± 1.8 vs. 7.1 % ± 1.5, P = 0.03) with a significant correlation between %PNI and ≥pT3 (r = 0.178, P = 0.027). After multivariate analysis, only cribriform formations were significantly associated with upstaging (P = 0.009). The presence of PNI in biopsies with GS 3 + 4 = 7 PCa is associated with upstaging at RP but is a weaker predictor of ≥pT3 disease than cribriform morphology.
authors.affiliation: The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada. tflood@toh.on.ca.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Flood
authors.affiliation: The Ottawa Hospital, Department of Medical Imaging, Ottawa, Canada.
authors.forename: Nicola
authors.initials: N
authors.lastname: Schieda
authors.affiliation: The Ottawa Hospital, Department of Urology, Ottawa, Canada.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Keefe
authors.affiliation: The Ottawa Hospital, Department of Urology, Ottawa, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Morash
authors.affiliation: The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Bateman
authors.affiliation: The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada.
authors.forename: Kien T
authors.initials: KT
authors.lastname: Mai
authors.affiliation: The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Belanger
authors.affiliation: The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Robertson
authors.affiliation: The Ottawa Hospital, Department of Urology, Ottawa, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
mesh_terms: D001706:Biopsy; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery
keywords: Gleason grade; active surveillance; perineural invasion; prostate; prostate biopsy; prostate cancer; radical prostatectomy