Predicting the Risk of Non–organ-confined Prostate Cancer When Perineural Invasion Is Found on Biopsy

Abstract

OBJECTIVE To more precisely define the risk of non–organ-confined (non-OC) prostate cancer among men with perineural invasion (PNI) identified on prostate biopsy. MATERIALS AND METHODS The Johns Hopkins radical prostatectomy database was queried for men with PNI reported on prostate biopsy. Patients with and without non-OC disease were compared for differences in preoperative clinical and pathologic characteristics, including three biopsy-based measures of tumor volume (number of cores with cancer, percentage of cores with cancer, and maximum percent core involvement with cancer). After evaluating the different preoperative variables in univariate analyses, a multivariable logistic regression model was generated, and bootstrap estimates of the risk of non-OC disease were calculated. RESULTS In total, 556 patients with PNI were analyzed, 279 (50.2%) of whom were found to have non-OC prostate cancer. In univariate analyses, preoperative prostate-specific antigen, clinical T stage, biopsy Gleason sum, and the three biopsy-based measures of tumor volume were significantly associated with non-OC disease. Of the three measures of tumor volume, the best fit to the data and highest degree of model discrimination were obtained using maximum percent core involvement with cancer. Incorporating this variable, preoperative prostate-specific antigen, clinical T stage, and biopsy Gleason sum into a multivariable model, the estimated risk of non-OC disease was found to range from 13.8% to 94.4% (bootstrap corrected c-index = 0.735). CONCLUSION Men with PNI on prostate biopsy are at a wide range of risk for non-OC disease. Preoperative estimation of this risk is improved by considering readily available biopsy estimates of tumor volume.

Impact of positive surgical margin location and perineural invasion on biochemical recurrence in patients undergoing radical prostatectomy

“…Our results showed that 30.5% of patients had PNI, while the incidence in other research ranged from 21.1 to 50.2% [ 13 , 27 – 30 ]. The variation between these studies may be associated with different patient groups or pathological criteria.…”

Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D’Amico low risk patients?

“…PNI in PNB was considered as an important criterion in the decisionmaking of active surveillance in several studies. Still, in these studies, PNI was associated with higher tumor volume, which did not indicate a poor prognosis (9)(10)(11). In an investigation performed by Walsh and Epstein in 1993, the authors reported that knowledge about the presence and extent of PNI in needle biopsy specimens might provide information about capsular penetration and aid in the decision-making process for nerve-sparing surgery (12).…”

Prognosis and Progression of ESCC Patients with Perineural Invasion

“…Non-standardized detecting methods may have contributed to the differences in the reported incidences of PNI. In the majority of reports, H&E staining was used to assess PNI 4 15 16 17 18 19 . However, determination of PNI is difficult and tedious by H&E if nerve fibers are severely damaged by invading tumor cells or if the nerve fibers are too thin.…”