Influence of biopsy perineural invasion on long-term biochemical disease-free survival after radical prostatectomy

O’Malley, Kiaran; Pound, Charles R.; Walsh, Patrick C.; Epstein, Jonathan I.; Partin, Alan W.

doi:10.1016/s0090-4295(01)01486-8

Cited by 51 publications

(31 citation statements)

References 25 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Methodsmentioning

confidence: 99%

“…The case-control study 22 paired all patients with perineural invasion identified in their initial cohort with patients without perineural invasion, matching them for Gleason grade and PSA level. Recruitment periods covered a period of 18 years, with no evidence of a trend toward different results over time.…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

“…Only 2 studies mentioned the issue of nerve sparing, 19,22 and reasons for sacrificing nerves were not related to the presence of perineural invasion on biopsy. Details were given only in the case-control study, 22 in which 89% of patients had at least 1 neurovascular bundle preserved, with similar rates reported for patients with and without perineural invasion.…”

Section: Surgical Seriesmentioning

confidence: 99%

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The prognostic significance of perineural invasion in prostatic cancer biopsies

Harnden

Shelley

Clements

et al. 2006

Cancer

154

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Men with clinically localized prostate cancer are faced with a wide range of treatment options, and only Gleason grading is universally used as a histopathological prognostic factor for this disease. The significance of perineural invasion in diagnostic biopsies is controversial. Opinion about whether or not it should influence treatment decisions is currently almost equally divided. To address this, the authors performed a systematic review of studies that examine the association between perineural invasion and prostate cancer recurrence. MEDLINE, Embase, and the Web of Knowledge were searched from January 1990 to December 2005.Outcomes analyzed were the development of biochemical or clinical recurrence. Twenty-one articles on the association of perineural invasion in biopsies and prostate cancer recurrence after radical prostatectomy (n ¼ 10) or radiotherapy (n ¼ 11) were found but none on its significance in the context of watchful waiting. Structured data extraction was performed to allow comparisons between articlesand to identify sources of heterogeneity to explain discrepancies in results. The considerable variation in study design, execution, and reporting precluded metaanalysis and quantitative risk estimation, but the weight of evidence suggested that perineural invasion in biopsies was a significant prognostic indicator, particularly in specific patient groups defined by presenting serum prostate-specific antigen levels and biopsy Gleason scores. Immediate treatment rather than watchful waiting may be more appropriate for patients with localized prostatic cancer and perineural invasion. However, the data are limited, and well-designed studies that use predefined stringent protocols are required to provide robust estimates of risk to aid in treatment planning.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

Section: Surgical Seriesmentioning

confidence: 99%

See 2 more Smart Citations

The prognostic significance of perineural invasion in prostatic cancer biopsies

Harnden

Shelley

Clements

et al. 2006

Cancer

154

View full text Add to dashboard Cite

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“…A number of studies have investigated the prognostic utility of perineural invasion in both thin core biopsies [3][4][5][6][7][8][9][10][11][12] and radical prostatectomy specimens [13][14][15][16][17][18][19][20] with variable results. In the majority of these studies, the absence or presence of perineural invasion was compared with outcome, although, in one study the diameter of the nerve and perineural infiltrate was investigated.…”

mentioning

confidence: 99%

Parameters of perineural invasion in radical prostatectomy specimens lack prognostic significance

et al. 2008

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The prognostic significance of perineural invasion by prostate cancer is debated. We have evaluated the association between biochemical failure and measurements of perineural invasion in radical prostatectomy specimens. Perineural invasion was identified in sections using S-100 protein immunostaining. For nerves showing invasion, the involved nerve closest to the edge of the prostate and to the surgical excision margin, as well as the diameter of these nerves, the largest nerve showing perineural invasion and its proximity to the excision margin, and the percentage of nerves showing perineural invasion up to 1.75 mm from the excision margin was determined and tested against time to prostate-specific antigen failure, along with preoperative prostate-specific antigen levels, highest Gleason primary grade, Gleason score and TNM T category. Perineural invasion was present in 90% of cases, with extraprostatic perineural invasion in 25% of tumors. Diameter of nerves showing perineural invasion ranged from 11 to 680 lm and the shortest distance to the surgical excision margin ranged from 33 to 2.57 mm. Perineural invasion density ranged from 6 to 96%. Gleason scores were six in 58 cases, seven in 43 cases, eight in three cases and nine in one case. Clinical T categories were T1c in 75 cases, T2a in 22 cases, T2b in five cases, T2c in two cases, T3 in one case. During a follow-up period of 11 to 55 months (median 26 months), 27 patients showed prostate-specific antigen failure. On univariate analysis only presence of extraprostatic perineural invasion, among parameters of perineural invasion, showed a weak correlation with outcome, while on multivariate analysis this lost significance and preoperative prostatespecific antigen levels, Gleason score and excision margin status were independently associated with biochemical failure. We conclude that the investigated parameters of perineural invasion do not predict prostate-specific antigen recurrence in radical prostatectomy specimens.

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