Investigating association of perineural invasion on prostate biopsy with Gleason score upgrading at prostatectomy: A multi‐institutional analysis

Abstract

BackgroundThe significance of perineural invasion (PNI) in prostate cancer (PC) is unclear. A recent report of patients with pT2N0R0 PC found that PNI at prostatectomy was independently associated with higher Gleason score and more diffuse prostatic disease. We aimed to test our hypothesis that PNI on prostate biopsy in pT2N0R0 patients is associated with increased Gleason score upgrading at prostatectomy.MethodsWe identified 2892 patients status post prostatectomy with pT2N0R0 PC from three institutions, diagnosed between 1 January 2008 and 31 December 2014. Multivariable logistic regression (MVA) was used to evaluate the association between prostate biopsy PNI status and surgical Gleason upgrading, while controlling for potential confounders.ResultsOf the 2892 patients identified, 14% had PNI on biopsy, of whom 21% had surgical Gleason upgrading, while 28% without PNI on biopsy had such upgrading (P < .01). On MVA, the odds ratio (OR) of surgical Gleason upgrading for patients with biopsy PNI relative to patients without biopsy PNI was 0.69 (P < .01). The variables associated with surgical Gleason upgrading were age ≤60 years (OR 1.22, P = .02) and preoperative PSA >4 ng/mL (OR 1.26, P = .02).ConclusionsIn post‐prostatectomy patients with favorable‐risk PC, PNI on prostate biopsy was not associated with surgical Gleason score upgrading. This may be due to the association of PNI with more diffuse disease, leading to increased biopsy tumor yield and grading accuracy. These findings suggest that in this setting, biopsy PNI alone should not be a concern for more aggressive disease requiring pathologic confirmation or intervention. This may help guide treatment decision‐making for men debating active surveillance, radiation, and surgery.

Prioritization of prostate cancer to immune checkpoint therapy by ranking tumors along IFN-γ axis and identification of immune resistance mechanisms

“…We identified pericytes cell type signature (Pericytes ENCODE 3 xcell p = 0.5E-04)and mesenchymal stem cell signature (MSC HPCA 3 xcell, p = 2.4E-04). Identified neuronal signature (Neurons ENCODE 2 xcell, p = 8.0E-07) in the metastatic IFN-γ-depleted subtype indicates presence of perineural invasion 60 , an indicator of aggressive prostate cancer 61,62 .…”

Clinicopathological factors associated with pathological upgrading from biopsy to prostatectomy in patients with ISUP grade group ≤2 prostate cancer

“…However, several recent studies about PNI on biopsy suggested that biopsy PNI seems less likely to predict GS upgrading. 28 Therefore, the association between biopsy PNI and Gleason grade upgrading warrant further investigation. For patients with biopsy PNI who are selected for AS, a repeat biopsy might be necessary.…”

Clinical Significance of Perineural Invasion in Men With Grade Group 1 Prostate Cancer on Active Surveillance

“…Previous studies that have evaluated the clinical significance of biopsy-detected PNI have yielded conflicting results. While some were unable to demonstrate an association with upgrading at prostatectomy 11 or BCR, 9 others found that PNI was associated with AP at RP 9,10 and BCR. 10 We found that patients with biopsy identified PNI were at increased risk of extraprostatic extension at RP compared to patients with no PNI, which is not surprising as PNI is a proven mechanism of PCa extracapsular spread.…”