Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer?

Reeves, Fairleigh; Hovens, Christopher M.; Harewood, Laurence; Battye, Shayne; Peters, Justin; Costello, Anthony J.; Corcoran, Niall M.

doi:10.5489/cuaj.2619

Cited by 26 publications

(20 citation statements)

References 16 publications

(19 reference statements)

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“…This is likely explained by the fact that we used a strict definition of PNI, that of circumferential encirclement of nerves by malignant glands. In contrast, prior studies reporting a higher PNI prevalence either did not describe how PNI was defined (14, 19, 20, 25, 39) or used vague descriptions such as presence of tumor cells “in the perineural space” (16, 18) or “along the perineural sheath” (21). Because the perineural space can often be difficult to identify using H&E stains alone, abutment of the perineural space by both malignant and benign glands can, in the absence of circumferential involvement, be misinterpreted as PNI (53, 54), resulting in misclassification.…”

Section: Discussionmentioning

confidence: 98%

Perineural Invasion and Risk of Lethal Prostate Cancer

Zareba

Flavin

Isikbay

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Prostate cancer has a propensity to invade and grow along nerves, a phenomenon called perineural invasion (PNI). Recent studies suggest that presence of PNI in prostate cancer has been associated with cancer aggressiveness. Methods We investigated the association between PNI and lethal prostate cancer in untreated and treated prostate cancer cohorts: the Swedish Watchful Waiting Cohort of 615 men who underwent watchful waiting, and the U.S. Health Professionals Follow-Up Study of 849 men treated with radical prostatectomy. One pathologist performed a standardized histopathologic review assessing PNI and Gleason grade. Patients were followed from diagnosis until metastasis or death. Results The prevalence of PNI was 7% and 44% in the untreated and treated cohorts, respectively. PNI was more common in high Gleason grade tumors in both cohorts. PNI was associated with enhanced tumor angiogenesis, but not tumor proliferation or apoptosis. In the Swedish study, PNI was associated with lethal prostate cancer (odds ratio, OR, 7.4, 95% confidence interval, CI, 3.6, 16.6; p<0.001). A positive, though not statistically significant, association persisted after adjustment for age, Gleason grade, and tumor volume (OR 1.9, 95% CI 0.8, 5.1; p=0.17). In the U.S. study, PNI predicted lethal prostate cancer independent of clinical factors (HR 1.8, 95% CI 1.0, 3.3; p=0.04). Conclusion These data support the hypothesis that perineural invasion creates a microenvironment that promotes cancer aggressiveness. Impact Our findings suggest that PNI should be a standardized component of histopathologic review, and highlights a mechanism underlying prostate cancer metastasis.

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Section: Discussionmentioning

confidence: 98%

Perineural Invasion and Risk of Lethal Prostate Cancer

Zareba

Flavin

Isikbay

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Similarly, Yu [ 19 ] and Wong [ 26 ] considered that PNI is an independent risk factor associated with an increased risk of BCR in patients who undergo external beam radiotherapy. On the contrary, Reeves [ 27 ] and Freedland [ 28 ] reported that PNI is not correlated with extracapsular extension and BCR in PCa after RP. Nevertheless, Weight [ 29 ] suggested that the presence of PNI is not a significant predictor of BCR in patients undergoing brachytherapy (BT) for PCa, and Ding[ 30 ] demonstrated a significant independent association between PNI and an increased risk of biochemical failure in 185 PCa patients who received BT.…”

Section: Discussionmentioning

confidence: 99%

Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis

Zhang

Zha

et al. 2018

BMC Urol

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BackgroundAlthough numerous studies have shown that perineural invasion (PNI) is linked to prostate cancer (PCa) risk, the results have been inconsistent. This study aimed to explore the association between PNI and biochemical recurrence (BCR) in patients with PCa following radical prostatectomy (RP) or radiotherapy (RT).MethodsAccording to the PRISMA statement, we searched the PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang databases from inception to May 2017. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were extracted from eligible studies. Fixed or random effects model were used to calculate pooled HRs and 95% CIs according to heterogeneity. Publication bias was calculated by Begg’s test.ResultsUltimately, 19 cohort studies that met the eligibility criteria and that involved 13,412 patients (82-2,316 per study) were included in this meta-analysis. The results showed that PNI was associated with higher BCR rates in patients with PCa after RP (HR=1.23, 95% CI: 1.11, 1.36, p<0.001) or RT (HR=1.22, 95% CI: 1.12, 1.34, p<0.001). No potential publication bias was found among the included studies in the RP group (p-Begg = 0.124) or the RT group (p-Begg = 0.081).ConclusionsThis study suggests that the presence of PNI by histopathology is associated with higher risk of BCR in PCa following RP or RT, and could serve as an independent prognostic factor in patients with PCa.

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“…Though there are opposing views in studies investigating the correlation between PNI positivity and BR, the majority of studies state that it may be an effective factor on BR rates. In a study of 1497 patients researching this topic and producing contrary results, though PNI positivity was reported not to have an effect on BR, they stated there was a significant correlation with RRP GS, high stage, surgical margin positivity and tumor volume [22]. Another of these studies assessed 3226 patients and showed that in patients with PNI, the advanced stage disease, surgical margin positivity and BR rates were significantly higher and adding PNI to PSA, PNB GS and clinical stage provided more significant results to predict local invasion [7].…”

Section: Discussionmentioning

confidence: 97%

Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy

Çelik

Bozkurt

Demir

et al. 2018

The Kaohsiung J of Med Scie

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To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS.

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Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer?

Cited by 26 publications

References 16 publications

Perineural Invasion and Risk of Lethal Prostate Cancer

Perineural Invasion and Risk of Lethal Prostate Cancer

Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis

Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy

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