Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy

Bonin, Steven R.; Hanlon, Alexandra L.; Lee, W. Robert; Movsas, Benjamin; Al‐Saleem, Tahseen; Hanks, Gerald E.

doi:10.1002/(sici)1097-0142(19970101)79:1<75::aid-cncr11>3.0.co;2-3

Cited by 64 publications

(40 citation statements)

References 21 publications

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“…27 In 1 paper, patients had locally advanced prostate cancer with a serum PSA level of 10 ng/mL, or a Gleason sum score of 7, or clinical stage T2b to T3c. 32 Exclusion criteria were variable and included a history of prior treatment, 18,[20][21][22][23][27][28][29]35 the unavailability of biopsies for review, 18,20,30 or the failure to obtain at least 4 biopsies. 18 In 2 articles, 19,36 in which perineural invasion was not the main focus, patients were excluded if the factor of interest could not be assessed.…”

Section: Resultsmentioning

confidence: 99%

“…Also excluded were articles reporting on the frequency of perineural invasion in patients with local recurrence 14 or on the outcomes of patients selected for small tumors and no perineural invasion, 15 as neither study had a control arm. The 10 surgical [16][17][18][19][20][21][22][23][24][25] and 11 radiotherapy [26][27][28][29][30][31][32][33][34][35][36] articles on perineural invasion in diagnostic biopsies form the basis of this report.…”

Section: Methodsmentioning

confidence: 99%

“…26,27,29,31,32,34,35 In unselected series of patients, 29,31,35 radiation dose correlated significantly with biochemical control. In series of patients selected for serum PSA values 27,29 of <10 ng/ mL or <20 ng/mL, treatment dose was not an independent predictor of outcome, whereas perineural invasion was significant. By contrast, when presenting PSA values were 20 ng/mL, patients who received a central prostate dose of 74 Grays (Gy) did significantly better than those who received lower doses (P ¼ .03 in multivariate analysis).…”

Section: Radiotherapy Series (Table 4)mentioning

confidence: 98%

“…One surgical 17 and 4 radiotherapy 28,29,34,35 articles included consecutive patients; the proportion of patients lost to follow-up in the remainder varied from 4% at 1 extreme 19 to 42.5% at the other. 18 …”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

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The prognostic significance of perineural invasion in prostatic cancer biopsies

Harnden

Shelley

Clements

et al. 2006

Cancer

155

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Men with clinically localized prostate cancer are faced with a wide range of treatment options, and only Gleason grading is universally used as a histopathological prognostic factor for this disease. The significance of perineural invasion in diagnostic biopsies is controversial. Opinion about whether or not it should influence treatment decisions is currently almost equally divided. To address this, the authors performed a systematic review of studies that examine the association between perineural invasion and prostate cancer recurrence. MEDLINE, Embase, and the Web of Knowledge were searched from January 1990 to December 2005.Outcomes analyzed were the development of biochemical or clinical recurrence. Twenty-one articles on the association of perineural invasion in biopsies and prostate cancer recurrence after radical prostatectomy (n ¼ 10) or radiotherapy (n ¼ 11) were found but none on its significance in the context of watchful waiting. Structured data extraction was performed to allow comparisons between articlesand to identify sources of heterogeneity to explain discrepancies in results. The considerable variation in study design, execution, and reporting precluded metaanalysis and quantitative risk estimation, but the weight of evidence suggested that perineural invasion in biopsies was a significant prognostic indicator, particularly in specific patient groups defined by presenting serum prostate-specific antigen levels and biopsy Gleason scores. Immediate treatment rather than watchful waiting may be more appropriate for patients with localized prostatic cancer and perineural invasion. However, the data are limited, and well-designed studies that use predefined stringent protocols are required to provide robust estimates of risk to aid in treatment planning.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Radiotherapy Series (Table 4)mentioning

confidence: 98%

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

See 2 more Smart Citations

The prognostic significance of perineural invasion in prostatic cancer biopsies

Harnden

Shelley

Clements

et al. 2006

Cancer

155

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“…Only serum PSA, proportion of the biopsy involved by cancer, and Gleason score were independent predictive factors. Bonin et al, 31 in a study of 484 patients with clinically localized PCa treated with three-dimensional conformal radiotherapy and followed for a median of 28 months, found that the presence of perineural invasion on the needle biopsy was associated with a significantly higher incidence of disease progression.…”

Section: Perineural Invasion In Rp Specimensmentioning

confidence: 99%

Radical prostatectomy for carcinoma of the prostate

et al. 2004

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Morphologic features of prostatic adenocarcinoma in the radical prostatectomy (RP) specimen are powerful prognostic indicators for prognosis for disease-free survival. This review discusses the methods of sampling of the RP specimen to optimize the detection of these morphologic features, balanced against the added expense of submitting the entire gland for sectioning. Gleason grade, one of the most powerful prognostic factors, is discussed briefly, including the percent pattern 4/5 cancer compared to the standard Gleason grading. Pathologic stage, as defined by the TNM system, is discussed in detail, both in terms of precise histological definition of each category, as well as the associated prognostic implications. Surgical margin status is also important prognostically across all pathologic stages categories. Perineural invasion, which has been used diagnostically in prostate cancer for several decades, has emerged as a very important prognostic indicator as well, as determined by the quantitative aspects of tumor in the perineural space. The effect of tumor volume on prognosis is discussed, as well as the newer concepts of the prognostic significance of zone of origin of the tumor and the presence or absence of intraductal carcinoma. Keywords: prostate carcinoma; pathologic stage; radical prostatectomy Radical prostatectomy (RP) for carcinoma of the prostate was performed and reported 100 years ago at the Johns Hopkins hospital by Dr Hugh Hampton Young who utilized a transperineal approach. He reported this and several other cases in the Bulletin of the Johns Hopkins Hospital. 1 Major impediments to utilizing RP in the years that followed related primarily to the almost universal presence of impotence and less commonly incontinence following the surgery. Also a large proportion of cases were first diagnosed with stage IV disease before widespread awareness of the disease and the advent of screening with serum prostate-specific antigen (PSA) in the late 1980s. In addition, initially there were high expectations for hormonal therapy in the 1940s and radiation therapy in the years that followed. However, it became clear very early that hormonal therapy could delay but not halt the progression of disease. Also radiotherapy was fraught with a high frequency of post-therapy positive biopsies and subsequent late recurrence; and for the latter, at times a much less differentiated tumor.The resurgence of RP for prostate cancer was brought about by another surgeon at Johns Hopkins, Patrick Walsh, MD, who along with Donker, reported on the anatomical distribution of nerves to the penile corpora in the male fetus. They subsequently designed an operation (now called 'anatomical RP') that would spare these nerves, which were located in the neurovascular bundle next to the postero-lateral aspect of the prostate. 2 In this paper he also reported a small series of patients he had treated by this new method of RP and reported postoperative potency rates. Although the postoperative potency rate were far from perfect, these res...

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Histopathologic review of prostate biopsies from patients referred to a comprehensive cancer center

Wurzer

Al‐Saleem

Hanlon

et al. 1998

Cancer

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BACKGROUND Clinicians at the Fox Chase Cancer Center (FCCC) base prostate carcinoma treatment decisions regarding need to treat, field size, total dose, and adjuvant hormonal therapy on known prognostic factors including clinical stage, Gleason score (GS), perineural invasion (PNI), and pretreatment prostate specific antigen levels. The pathology of every patient is reviewed at FCCC to confirm a diagnosis of malignancy. The objective of this study was to define differences between pathologic reviews and their impact on treatment between outside institutions and FCCC. METHODS The authors reviewed 538 pathology reports of prostate biopsies performed at both outside pathology departments and FCCC on patients evaluated between January 1993 and December 1996. The outside pathology reviews represented 107 community hospitals, academic institutions, and private pathology laboratories. Patients who had received hormonal therapy, cryosurgery, or radical prostatectomy prior to prostate biopsy were excluded from analysis. Final FCCC pathology determinations were compared with pathology reports from outside institutions. Reports then were analyzed to determine whether differences in interpretation would have resulted in different treatment strategies. Differences in percentages according to institutional type were evaluated using the chi‐square statistic. The cost was assessed and cost per change in treatment estimated. RESULTS The 538 pathology reviews identified a nearly 40% change in GS and a 13% change in ≥2 GS between the FCCC pathology review and 107 outside academic institutions. The results of this study showed that 22% of community hospitals, 10% of private laboratories, and 8% of academic institutions demonstrated at least 2 GS changes compared with the FCCC pathology review (p = 0.001). There was no significant difference observed between types of institutions in the incidence of PNI. CONCLUSIONS This analysis provides evidence of a significant difference in the pathologic reviews of prostate biopsies conducted at FCCC and outside pathology departments. There was a nearly 40% change in GS and a 13% change in ≥2 GS between the FCCC pathology review and 107 outside institutions. The second pathology review added approximately $104 per case for a total of $55,952 to review all 538 cases. Overall, the savings in health care dollars resulting from the second pathologic review totaled $12,997. This second review of outside pathology in prostate cancer appears to be justified based on the treatment changes and on cost. Cancer 1998;83:753‐759. © 1998 American Cancer Society.

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Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy

Cited by 64 publications

References 21 publications

The prognostic significance of perineural invasion in prostatic cancer biopsies

The prognostic significance of perineural invasion in prostatic cancer biopsies

Radical prostatectomy for carcinoma of the prostate

Histopathologic review of prostate biopsies from patients referred to a comprehensive cancer center

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