Pathologic features from prostate needle biopsy and prognosis after I-125 brachytherapy

Abstract

To evaluate the role of detailed pathologic features in predicting outcome for early‐stage prostate cancer treated with I‐125 brachytherapy. The pretreatment biopsy slides of 103 patients with T1/T2 and Gleason scores of 4–7 prostatic carcinoma, which was treated by transperineal I‐125 implantation, were reviewed retrospectively by a single pathologist (P.B.G.). Biochemical tumor control rates [prostate‐specific antigen (PSA) below 1.0] were correlated with pretreatment PSA, Gleason score, the amount of tumor in the biopsy samples, and the presence of perineural invasion.In Cox proportional‐hazard, multivariate analysis, the strongest predictors of failure were pretreatment PSA above 10 ng/ml (P = 0.013) and the length of the biopsy specimen replaced by tumor (P = 0.15). The percent of biopsy tissue replaced by tumor (P = 0. 74), perineural invasion (P = 0.78), and Gleason score (P = 0.66) were less predictive of prognosis. It was concluded that pretreatment PSA is the strongest predictor of biochemical failure. Detailed assessment of pathological features on needle biopsy added little prognostic information beyond that of pretreatment PSA alone. Like all other prognostic parameters for prostate cancer, there is considerable overlap in pathologic features between those patients who will or will not be controlled biochemically. Radiat. Oncol. Invest. 6:170–174, 1998. © 1998 Wiley‐Liss, Inc.

The prognostic significance of perineural invasion in prostatic cancer biopsies

“…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.…”

“…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.…”

“…Four studies provided the median 18,23,32 and/or the mean 18,23,25,32 number of biopsy cores taken from each patient, which ranged from 6 to 7 for the median and 5.5 to 7 for the mean. Six of the surgical [16][17][18][19]23,25 and 1 of the radiotherapy 32 studies gave the range of the number of cores taken, varying from 1 core, 17 Perineural invasion was defined in 7 articles, 18,27,28,30,[32][33][34] with 1 article 32 restricting the definition to invasion of large nerves only. None of the 21 articles gave the proportion of patients with nerves present in their biopsies.…”

“…Twelve studies [16][17][18][19][20][21]25,28,[32][33][34]36 stated that 100% of biopsies were reviewed for the presence of perineural invasion, and 1 study 30 stated that 60% of biopsies were reviewed for the presence of perineural invasion. In 5 studies, 23,26,27,29,35 the slides were not reviewed but the diagnosis taken from the original report.…”

“…In 7 articles, 16,19,28,30,[32][33][34] a single pathologist reviewed slides, but in 1 article 30 only 60% of cases were reviewed, so that other pathologists were presumably involved in 40%. The review was performed by 2 pathologists in a further 2 articles, 17,25 and 7 articles involved multiple pathologists.…”