Prediction of Extraprostatic Extension in the Neurovascular Bundle Based on Prostate Needle Biopsy Pathology, Serum Prostate Specific Antigen and Digital Rectal Examination

Abstract

The model generated in this study allows for the preoperative identification of patients with 10% or greater probability of EPE in the NVB. Our algorithm will help provide objective parameters that aid in the decision to spare the NVB safely.

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

“…In a multivariate analysis of preoperative PSA levels, GS, digital rectal examination, tumor volume and PNI, PNI could predict extraprostatic invasion in nearly 10% of the cases (15). However in another study, any correlation between PNI and GS estimated based on histopathological examination of RRP specimens, extraprostatic extension, SMP, LVI and upgrading of the tumor was not detected (16).…”

Prostate Volume and the Incidence of Extraprostatic Extension: Is There a Relation?

“…1,2 Incidence and oncologic impact of various biopsy Gleason sum and EPE varies significantly with increasing serum prostate specific antigen (PSA) level, tumor volume, and sometimes volume of the gland harboring the tumor. While the relationship between Gleason sum, EPE, PSA level, and tumor volume are well studied, [3][4][5][6] there is paucity of data regarding relationship between prostate volume and known oncologic variables, such as Gleason sum, percentage cancer, clinical stage, and EPE.…”

Does tumor extent on needle prostatic biopsies influence the value of perineural invasion to predict pathologic stage > T2 in radical prostatectomies?

“…In Bismar's et al study (11) neither presence nor absence of perineural nor number nor percentage of positive nerves were related to pathologic stage on univariate or multivariate analyses. In Tsuzuki's et al study (12) PSA, Gleason score, digital rectal examination, percent of side specific cores with tumor and average percent involvement of each positive core but not PNI were found to be statistically significant independent predictors of extraprostatic extension in the region of the neurovascular bundle. Studying 452 consecutive patients undergoing radical retropubic prostatectomy by a single surgeon, Cannon et al (13) concluded that although biopsy PNI alone was associated with a higher probability of extraprostatic extension, it was not predictive of bilateral nervesparing technique or a positive surgical margin in an individual patient.…”

“…Perineural invasion (PNI) on needle prostatic biopsies as a marker of extraprostatic extension has been controversial (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In almost all studies, perineural invasion has been related to extraprostatic extension in univariate analysis but in only a few Clinical Urology Clinical Urology doi: 10.1590/S1677-55382010000400007 studies in multivariate analysis.…”