Perineural invasion on biopsy is associated with upstaging at radical prostatectomy in Gleason score 3 + 4 = 7 prostate cancer

Flood, Trevor A.; Schieda, Nicola; Keefe, Daniel T.; Morash, Chris; Bateman, Justin; Kien, T.; Belanger, Eric C.; Robertson, Susan J.; Breau, Rodney H.

doi:10.1111/pin.12467

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…Previous studies included patients with PCa at various clinical stages, and the proportions of patients included within each stage varied, leading to different conclusions. In addition, some studies 41 , 42 , 43 have pointed out that the risk of PNI may vary across different Gleason scores. We thus divided the patients into two subgroups based on GG and found that PNI was significantly associated with EPE only in the group of patients with GG ≥3 but not in the group with GG <3, suggesting the association between PNI and EPE may be dependent on GG.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

Jiang

Liang

et al. 2023

Cancer Medicine

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BackgroundAccurate assessment of the clinical staging is crucial for determining the need for radical prostatectomy (RP) in prostate cancer (PCa). However, the current methods for PCa staging may yield incorrect results. This study aimed to comprehensively analyze independent predictors of postoperative upstaging of intraprostatic cancer.MethodsWe conducted a retrospective analysis of data from intraprostatic cancer patients who underwent radical surgery between March 2019 and December 2022. Intraprostatic cancer was defined as a lesion confined to the prostate, excluding cases where multiparameter magnetic resonance imaging (mpMRI) showed the lesion in contact with the prostatic capsule. We assessed independent predictors of extraprostatic extension (EPE) and analyzed their association with positive surgical margin (PSM) status. In addition, based on the distance of the lesion from the capsule on mpMRI, we divided the patients into non‐transition zone and transition zone groups for further analysis.ResultsA total of 500 patients were included in our study. Logistic regression analysis revealed that biopsy Gleason grade group (GG) (odds ratio, OR: 1.370, 95% confidence interval, CI: 1.093–1.718) and perineural invasion (PNI) (OR: 2.746, 95% CI: 1.420–5.309) were predictive factors for postoperative EPE. Both biopsy GG and PNI were associated with lateral (GG: OR: 1.270, 95% CI: 1.074–1.501; PNI: OR: 2.733, 95% CI: 1.521–4.911) and basal (GG: OR: 1.491, 95% CI: 1.194–1.862; PNI: OR: 3.730, 95% CI: 1.929–7.214) PSM but not with apex PSM (GG: OR: 1.176, 95% CI: 0.989–1.399; PNI: OR: 1.204, 95% CI: 0.609–2.381) after RP. Finally, PNI was an independent predictor of EPE in the transition zone (OR: 11.235, 95% CI: 2.779–45.428) but not in the non‐transition zone (OR: 1.942, 95% CI: 0.920–4.098).ConclusionPNI and higher GG may indicate upstaging of tumors in patients with intraprostatic carcinoma. These two factors are associated with PSM in locations other than the apex of the prostate. Importantly, cancer in the transition zone of the prostate is more likely to spread externally through nerve invasion than cancer in the non‐transition zone.

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Section: Discussionmentioning

confidence: 99%

Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

Jiang

Liang

et al. 2023

Cancer Medicine

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“…Sarbay et al ( 24 ), reported that cribriform morphology on prostate biopsy was associated with an increased likelihood of positive surgical margins and extraprostatic extension at the time of RP. Another study showed that perineural invasion on biopsy was associated with adverse pathology at the time of RP; however, perineural invasion was inferior to cribriform pattern in predicting non-organ-confined disease at the time of RP ( 25 ). Over the past few years, several studies have shown that cribriform-positive PCa is associated with an increased likelihood of lymph node invasion and distant metastasis ( 10 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of a nomogram incorporating cribriform morphology for the prediction of adverse pathology in prostate cancer at radical prostatectomy

et al. 2020

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The aim of the present study was to develop a novel nomogram that incorporated clinical factors, imaging parameters and biopsy pathological factors (including cribriform morphology) to predict adverse pathology in prostate cancer (PCa). A total of 223 patients with PCa, who had undergone preoperative multi-parametric magnetic resonance imaging and had a biopsy of Gleason pattern (GP) 4, absence of GP 5 and pure Grade Group (GG) 3 [Gleason score (GS) 3+4, GS 4+3, GS 4+4], were retrospectively enrolled onto the study. The contribution of GG to the biopsy and Prostate Imaging Reporting and Data System (PI-RADS) score for PCa harboring adverse pathology were analyzed. Univariate and multivariate logistic regression analyses were performed to determine significant pathology predictors of adverse pathology for nomogram development. The nomogram was internally validated using bootstrapping with 1,000 iterations. The diagnostic performance of the nomogram was analyzed by receiver operating characteristics (ROC) analysis and decision curve analysis (DCA). A higher biopsy GG and PI-RADS score were associated with an increased likelihood of adverse pathology. Prostate specific antigen density (PSAD), biopsy GG, cribriform morphology on biopsy and PI-RADS score were significant predictors and were included in the nomogram. The ROC area under the curve of the nomogram was 0.88 (95% confidence interval, 0.84-0.91), with a high specificity (0.91) and moderate sensitivity (0.72). The novel nomogram was shown to have a higher net benefit for the prediction of adverse pathology in PCa, compared with any individual factors determined by DCA. Overall, a novel nomogram incorporating PSAD, PI-RADS score, biopsy GG and cribriform morphology on biopsy was shown to perform well in the prediction of PCa harboring adverse pathology at the time of radical prostatectomy.

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“…Since then a large number of papers have been published on PNI, but very few which use prostate cancer death as the outcome. Many studies, even those in the recent literature, use pathological factors as surrogates for outcome [ 5 – 8 ]. Others use progression usually defined by biochemical recurrence [ 9 – 11 ] or metastasis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively

et al. 2018

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The identification of perineural invasion (PNI) and extraprostatic extension (ECE) in prostate cancer (PC) biopsies is time consuming and can be difficult. Although this is required information in many datasets, there is little evidence on their effect on outcome in patients treated conservatively. Cases of PC were identified from three cancer registries in the UK from men with clinically localized prostate cancer diagnosed by needle biopsy from 1990–2003. The endpoint was prostate cancer death (DOD). Patients treated radically within 6 months, those with objective evidence of metastases or who had prior hormone therapy were excluded. Follow-up was through cancer registries up until 2012. Deaths were divided into those from PC and those from other causes, according to WHO criteria. 988 biopsy cases (6522 biopsy cores) were centrally reviewed by three uropathologists and assigned a Gleason score and Grade Group (GG). The presence of both PNI and ECE was recorded. Of 988 patients, PNI was present in 288 (DOD = 75) and ECE in 23 (DOD = 5). On univariable analysis PNI was highly significantly associated with DOD (hazard ratio [HR] 2.28, 95% CI: 1.68, 3.1, log-rank test p-value = 4.8 × 10–8), but ECE was not (log-rank test p-value = 0.334). On multivariable analysis with GG, serum PSA (per 10%), clinical stage and extent of disease (per 10%), PNI lost significance (HR 1.16, 95% CI: 0.83, 1.63, likelihood ratio test p-value = 0.371). The utility of routinely examining prostate biopsies for ECE and PNI is doubtful as it is not independently associated with higher grade, stage or prognosis.

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Perineural invasion on biopsy is associated with upstaging at radical prostatectomy in Gleason score 3 + 4 = 7 prostate cancer

Cited by 12 publications

References 21 publications

Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

Diagnostic performance of a nomogram incorporating cribriform morphology for the prediction of adverse pathology in prostate cancer at radical prostatectomy

Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively

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