Perineural invasion by prostate cancer on MR/US fusion targeted biopsy is associated with extraprostatic extension and early biochemical recurrence after radical prostatectomy

e595 Background: Perineural invasion (PNI) is a distinct pathologic entity and a recognized source of tumor spread. However, the role of PNI in high-risk prostate cancer (PCa) has not been explored. We investigated the impact of the severity of PNI on biochemical recurrence (BCR) and optimal timing of adjuvant androgen deprivation therapy (ADT) post radical prostatectomy (RP). Methods: Of 265 prostatectomies, median follow-up 45 months, were assessed for the presence of PNI and its intensity (unifocal PNI and multifocal PNI) in RP specimen. Kaplan-Merier curves were used to estimate BCR probabilities. Cox proportional hazard models were used to address predictors of BCR. Harrell’s C-index was conducted to further validate prognostic value of multi-PNI. Results: A total of 123 patients (46.4%) were PNI positive, among which, 91 (74%) and 32 (26%) had unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. Other than uni-PNI, the presence of multi-PNI was strongly associated with increasing incidence of BCR (HR = 3.87, 95% CI: 1.66-9.01, p = 0.002). Patients with uni-PNI seemed to have a similar BCR rate to those without PNI after adjuvant ADT. For men with multi-PNI, immediate ADT obviously appeared to be superior to delayed ADT in decreasing biochemical failure. Conclusions: Multi-PNI detected in high-risk RP specimens could be a prognosticator for early biochemical relapse post-surgery. Our findings suggest that patients with multi-PNI appear appropriate to choose adjuvant therapy as soon as possible after surgery.

Download Full-text

Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer?

Canadian Urological Association Journal ◽

10.5489/cuaj.2619 ◽

2015 ◽

Vol 9 (5-6) ◽

pp. 252 ◽

Cited By ~ 12

Author(s):

Fairleigh Reeves ◽

Christopher M. Hovens ◽

Laurence Harewood ◽

Shayne Battye ◽

Justin S. Peters ◽

...

Keyword(s):

Prostate Cancer ◽

Regression Analysis ◽

Radical Prostatectomy ◽

Gleason Score ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Cox Regression ◽

Clinicopathological Parameters ◽

Positive Surgical Margin ◽

Cox Regression Analysis

Introduction: The ability of perineural invasion (PNI) in radical prostatectomy (RP) specimens to predict biochemical recurrence (BCR) is unclear. This study investigates this controversial question in a large cohort.Methods: A retrospective analysis was undertaken of prospectively collected data from 1497 men who underwent RP (no neoadjuvant therapy) for clinically localized prostate cancer. The association of PNI at RP with other clinicopathological parameters was evaluated. The correlation of clinicopathological factors and BCR (defined as prostate-specific antigen [PSA] >0.2 ng/mL) was investigated with univariable and multivariable Cox regression analysis in 1159 men.Results: PNI-positive patients were significantly more likely to have a higher RP Gleason score, pT3 disease, positive surgical margins, and greater cancer volume (p < 0.0005). The presence of PNI significantly correlated with BCR on univariable (hazard ratio 2.30, 95% confidence interval 1.50–3.55, p < 0.0005), but not multivariable analysis (p = 0.602). On multivariable Cox regression analysis the only independent prognostic factors were preoperative PSA, RP Gleason score, pT-stage, and positive surgical margin status. These findings are limited by a relatively short follow-up time and retrospective study design.Conclusions: PNI at RP is not an independent predictor of BCR. Therefore, routine reporting of PNI is not indicated. Future research should be targeted at the biology of PNI to increase the understanding of its role in prostate cancer progression.

Download Full-text

The added value of concomitant systematic biopsy in predicting biochemical recurrence after radical prostatectomy in patients with prostate cancer diagnosed by MRI-targeted biopsy

European Urology Open Science ◽

10.1016/s2666-1683(20)35385-4 ◽

2020 ◽

Vol 20 ◽

pp. S58

Author(s):

A. Rizzo ◽

G. Gandaglia ◽

G. Ploussard ◽

M. Valerio ◽

A. Mattei ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Added Value ◽

Targeted Biopsy ◽

Systematic Biopsy

Download Full-text

The impact of multifocal perineural invasion on biochemical recurrence and timing of adjuvant androgen-deprivation therapy in high-risk prostate cancer following radical prostatectomy

The Prostate ◽

10.1002/pros.23388 ◽

2017 ◽

Vol 77 (12) ◽

pp. 1279-1287 ◽

Cited By ~ 7

Author(s):

Guangxi Sun ◽

Rui Huang ◽

Xingming Zhang ◽

Pengfei Shen ◽

Jing Gong ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Androgen Deprivation Therapy ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Androgen Deprivation ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

The Impact

Download Full-text

Revisiting extraprostatic extension based on invasion depth and number for new algorithm for substaging of pT3a prostate cancer

Scientific Reports ◽

10.1038/s41598-021-93340-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cheol Keun Park ◽

Yeon Seung Chung ◽

Young Deuk Choi ◽

Won Sik Ham ◽

Won Sik Jang ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Radial Distance ◽

Image Analyzer ◽

Two Dimensional ◽

Invasion Depth ◽

Free Survival ◽

Extraprostatic Extension

AbstractExtraprostatic extension (EPE) is a factor in determining pT3a stage in prostate cancer. However, the only distinction in EPE is whether it is focal or non-focal, causing diagnostic and prognostic ambiguity. We substaged pT3a malignancies using classification of EPE to improve personalized prognostication. We evaluated 465 radical prostatectomy specimens with a digital image analyzer by measuring the number, radial distance and two-dimensional square area of the EPE. The most significant cut-off value was proposed as an algorithm for the pT3a substaging system to predict biochemical recurrence (BCR). A combination of the radial distance and the number of EPEs predicted BCR the most effectively. The optimal cut-off criteria were 0.75 mm and 2 mm in radial distance and multifocal EPE (hazard ratio: 2.526, C-index 0.656). The pT3a was subdivided into pT3a1, < 0.75 mm and any number of EPEs; pT3a2, 0.75–2 mm and one EPE; and pT3a3, > 2 mm and any number of EPEs or 0.75–2 mm and ≥ 2 EPEs. This combined tier was highly significant in the prediction of BCR-free survival. The combination of radial distance and number of EPEs could be used to subdivide pT3a prostate cancer and may aid in the prediction of BCR.

Download Full-text

High-risk prostate cancer: factors predicting biochemical recurrence after radical prostatectomy

Acta medica Lituanica ◽

10.6001/actamedica.v22i3.3199 ◽

2015 ◽

Vol 22 (3) ◽

pp. 161-168

Author(s):

Albertas Ulys ◽

Agnė Ulytė ◽

Pavel Dziameshka ◽

Oleg Sukonko ◽

Sergei Krasny ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Surgical Margins ◽

T Stage ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Background/objective. Predictive criteria are needed to evaluate the risk of disease progression after radical prostatectomy. Such criteria would help to select patients most likely to benefit from adjuvant or multimodality treatment. Our aim was to identify predictive factors for biochemical recurrence among the pre- and post-operative parameters in high-risk prostate cancer patients after radical prostatectomy. Methods. Data on high-risk prostate cancer patients between 2005 and 2009 were retrospectively reviewed in two cancer centers: National Cancer Institute, Vilnius, Lithuania, and N. N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus. 199 patients were selected for the study. The pre-operative independent variables were T stage, pretreatment PSA level and Gleason score. Surgical margins and perineural invasion were additionally known for 122 patients. The outcomes measured were biochemical recurrence free and overall survival. The mean follow-up time was 5.8 years. Results. Lower T stage (p = 0.001) and pretreatment PSA (p = 0.0001) were associated with better survival. In the multivariate analysis of pre-operative factors, high T stage (p = 0.008) and pretreatment PSA (p = 0.009) were predictive of biochemical recurrence. When postoperative parameters were included in the multivariate analysis, only pretreatment PSA (p = 0.01), positive surgical margins (p = 0.003) and perineural invasion (p = 0.03) remained relevant independent predictors of biochemical recurrence. Conclusions. Pretreatment PSA, positive surgical margins and perineural invasion were independent predictors of biochemical recurrence after radical prostatectomy in high-risk prostate cancer patients, while the T stage became insignificant after adjusting for postoperative parameters.

Download Full-text

Prognostic value of perineural invasion in prostate needle biopsies: a population-based study of patients treated by radical prostatectomy

Journal of Clinical Pathology ◽

10.1136/jclinpath-2019-206300 ◽

2020 ◽

Vol 73 (10) ◽

pp. 630-635

Author(s):

Peter Ström ◽

Tobias Nordström ◽

Brett Delahunt ◽

Hema Samaratunga ◽

Henrik Grönberg ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Prognostic Value ◽

Perineural Invasion ◽

Population Based ◽

Advanced Stage ◽

Malignant Tumours ◽

Prostatic Biopsy ◽

Increased Risk

AimsDespite being one of the major pathways for the spread of malignant tumours, perineural invasion (PNI) has not conclusively been shown to have an independent prognostic value for prostate cancer. Prostatic biopsy constitutes the major pathology workload in prostate cancer and is the foundation for primary treatment decisions and for this reason we aimed to estimate the prognostic value of PNI in biopsies.MethodsWe followed 918 men who underwent radical prostatectomy (RP) from the prospective and population based STHLM3 study until biochemical recurrence with a median follow-up of 4.1 years. To strengthen the evidence, we combined the estimates from the largest studies targeting the prognostic value of PNI in the biopsy. We also estimated the OR of advanced stage as radical prostatectomy for PNI positive and negative men.ResultsThe estimated prognostic value based on our data suggested an approximately 50% increased risk of biochemical recurrence if PNI was present in the biopsy (p=0.06). Even though not statistically significant on the 5% level, this estimate is consistent with similar studies, and by combining the estimates there is in fact strong evidence in support of an independent prognostic value of PNI in the biopsy (p<0.0001). There was also an independent increased risk of advanced stage at RP for positive men (OR 1.85, p=0.005).ConclusionsThe evidence supporting a clinically relevant and independent prognostic value of PNI is strong enough to be considered for pathology reporting guidelines.

Download Full-text