Correlation of Perineural Invasion with Biochemical Recurrence and Negative Pathological Features in Prostate Adenocarcinoma

115 Background: Predictors of biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical recurrence. Methods: 774 patients with at least 3 year follow up had undergone RALP by a single surgeon at our institution. Biochemcial recurrence was defined as a postoperative PSA >0.2 ng/ml. Multivariable logistic regression models were used to develop the biochemical recurrence predictive nomograms: nomogram 1- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion; nomogram 2- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion, nerve sparing, positive surgical margins (none, unifocal, or multifocal). The predictive accuracy of the models was assessed in terms of discrimination and calibration. Results: Both nomograms discriminated well between patients that recurred and those that did not (bootstrap corrected c-indices of 0.766 and 0.806 for nomograms 1 and 2 respectively). Nomogram 1 was well calibrated, but nomogram 2 over- predicted the probability of biochemical recurrence in patients at >30% risk. Conclusions: Our nomogram based on age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, and perineural invasion on preoperative biopsy has a good predictive ability to differentiate between RALP-treated patients that biochemically recur by 3 years from those that do not. Adding nerve sparing and surgical margin status further improved discriminatory ability but at the expense of over-prediction for patients at high risk. These nomograms may be used to guide the use of nerve sparing and the management of positive margins in men undergoing RALP for clinically localized prostate cancer. No significant financial relationships to disclose.

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Smaller Prostate Volume is Associated with Adverse Pathological Features and Biochemical Recurrence after Radical Prostatectomy

Urological Science ◽

10.4103/uros.uros_28_19 ◽

2019 ◽

Vol 30 (6) ◽

pp. 255

Author(s):

Pranav Sharma ◽

John Buie ◽

Werner De Riese

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Prostate Volume ◽

Pathological Features

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.e595 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. e595-e595

Author(s):

Pengfei Shen ◽

Guangxi Sun ◽

Hao Zeng ◽

Xingming Zhang

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

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.

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Risk of biochemical recurrence (BCR) in prostate cancer (PCa) patients (pts) with perineural invasion (PNI): Systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e17060 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e17060-e17060

Author(s):

Stephanie Fletcher ◽

Nimer Alsaid ◽

Chinmayee Katragadda ◽

Jennifer Martin ◽

Hani M. Babiker ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Meta Analysis

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Abstract A19: Identification of somatic alterations in prostate adenocarcinoma with intermediate Gleason score with and without biochemical recurrence

10.1158/1557-3265.tcm17-a19 ◽

2018 ◽

Author(s):

Isabella Meira ◽

Bruna Barros ◽

Rodrigo Ramalho ◽

José Kroll ◽

Renan Almeida ◽

...

Keyword(s):

Gleason Score ◽

Biochemical Recurrence ◽

Prostate Adenocarcinoma ◽

Somatic Alterations

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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.

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