Prediction of Perineural Invasion and Its Prognostic Value in Patients with Prostate Cancer

Lee, Jun Taik; Lee, Seungsoo; Yun, Chang Jin; Jeon, Byung Joo; Kim, Jung Man; Ha, Hong Koo; Lee, Wan; Chung, Moon Kee

doi:10.4111/kju.2010.51.11.745

Cited by 34 publications

(31 citation statements)

References 18 publications

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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: 99%

“…Of the more than 30 studies that have examined the association between PNI in radical prostatectomy specimens and prostate cancer outcomes (see Table 2), only three (18, 26, 38) have assessed whether PNI predicts distant metastases or death, with the remainder focusing on biochemical recurrence as the outcome of interest. This is important given that most men who develop a biochemical recurrence are not destined to die of their disease (44–46).…”

Section: Discussionmentioning

confidence: 99%

“…Only three studies (18, 26, 38) have examined PNI as a predictor of prostate cancer-specific mortality in men treated with surgery, with only one of them (38) showing PNI to predict mortality on multivariate analysis. This is critical as most men who develop a biochemical recurrence are not destined to develop lethal prostate cancer (44–46).…”

Section: Introductionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perineural Invasion and Risk of Lethal Prostate Cancer

Zareba

Flavin

Isikbay

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Although a number of studies have found that PNI predicts BCR on univariable analysis, [7][8][9][10][11][12][13][14][15] only two studies have reported PNI as a significant predictor on multivariable analysis. 8,13 Both of these studies examined relatively small cohorts of fewer than 250 participants.…”

Section: Discussionmentioning

confidence: 99%

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

Reeves

Hovens

Harewood

et al. 2015

CUAJ

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Introduction: The ability of perineural invasion (PNI) in radical prostatectomy (RP) specimens to predict biochemical recurrence (BCR) is unclear. This study investigates this controversial question in a large cohort. Methods: A retrospective analysis was undertaken of prospectively collected data from 1497 men who underwent RP (no neoadjuvant therapy) for clinically localized prostate cancer. The association of PNI at RP with other clinicopathological parameters was evaluated. The correlation of clinicopathological factors and BCR (defined as prostate-specific antigen [PSA] >0.2 ng/mL) was investigated with univariable and multivariable Cox regression analysis in 1159 men. Results: PNI-positive patients were significantly more likely to have a higher RP Gleason score, pT3 disease, positive surgical margins, and greater cancer volume (p < 0.0005). The presence of PNI significantly correlated with BCR on univariable (hazard ratio 2.30, 95% confidence interval 1.50-3.55, p < 0.0005), but not multivariable analysis (p = 0.602). On multivariable Cox regression analysis the only independent prognostic factors were preoperative PSA, RP Gleason score, pT-stage, and positive surgical margin status. These findings are limited by a relatively short follow-up time and retrospective study design. Conclusions: PNI at RP is not an independent predictor of BCR. Therefore, routine reporting of PNI is not indicated. Future research should be targeted at the biology of PNI to increase the understanding of its role in prostate cancer progression.

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“…[46][47][48] Jeon et al [49] also reported that patients with PNI have higher GS, ECI, SVI, and PSM. Lee et al's [50] 2010 study showed that PNI presence was related to lymph node invasion, higher GS, PSM, higher tumor volume, and late-term PC; however, PNI was not an independent risk factor for BCR in multivariate analysis. Our study results were similar to the ones in the literature that show no relation between PNI and BCR (p=0.548).…”

Section: Discussionmentioning

confidence: 98%

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy

Ün¹,

Türk²,

Koca³

et al. 2015

Turkish Journal of Urology

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Objective: This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP). Material and methods:We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study. Results:The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p= 0.004), capsular invasion (CI) (p= 0.001), age (p= 0.014), and tumor size (p= 0.006). However, only CI was found to be significant in multivariate analysis (p= 0.001). Conclusion:Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.

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Prediction of Perineural Invasion and Its Prognostic Value in Patients with Prostate Cancer

Cited by 34 publications

References 18 publications

Perineural Invasion and Risk of Lethal Prostate Cancer

Perineural Invasion and Risk of Lethal Prostate Cancer

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

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy

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