Prognostic Role of Perineural Invasion in 239 Consecutive Patients with Pathologically Organ-Confined Prostate Cancer

Abstract

Objective: The aim of our study was to analyze the role of perineural invasion (PNI) as a predictive parameter of outcome after radical prostatectomy (RRP) in pathologically organ-confined prostate cancer (PCa) and to assess its possible correlation with other well-known prognostic features. Patients and Methods: At our institution between January 2000 and December 2007, we prospectively collected data from 251 consecutive patients with pathologically localized PCa after antegrade RRP. In our analysis 239 patients were included. PNI was defined as adenocarcinoma within the perineural space adjacent to a nerve. We evaluated the biochemical progression-free survival rate using the Kaplan-Meier method to establish the correlation between PNI and prognosis, the log-rank test to verify the statistical significance, and χ² test to investigate the correlation between PNI and other clinicopathological parameters. Results: We found intraprostatic PNI in 157 patients (65.7%). The PNI rate was 73% (149/204) in pT2b–c vs. 26% (8/35) in pT2a surgical specimens (p < 0.001), and it was 78.5% (73/93) in patients with a Gleason score of 7–10 vs. 57% (84/146) in a Gleason score of 2–6 (p < 0.01). The mean follow-up was 65.4 (median 62, range 24–118) months. Overall, 11/239 (4.6%) patients presented biochemical recurrence after surgery and 7 (63.6%) of these patients showed PNI, but this was not statistically higher than in patients free from progression (150/228, 65.7%). The actuarial biochemical progression-free survival rate for all patients was 96.9 and 93.5% at 60 and 84 months, respectively, and the stratification based on the presence or absence of PNI did not allow us to identify different prognostic groups. Conclusions: Perineural infiltration frequently takes part in the pathway of extraprostatic extension. In our series, patients with pathological T2 stages and PNI were found to present a higher pT2 stage and Gleason score, even though our early biochemical-free outcome was not significantly higher than in patients without PNI.

Genotypic and phenotypic analysis of familial male breast cancer shows under representation of the HER2 and basal subtypes in BRCA-associated carcinomas

“…In our study, we confirmed many but also identified PNI as being of prognostic significance, which has not been reported previously in MBC. Its presence, being double most rates reported in FBC [52,53], may be due to frequent subareolar tumour location which is less frequently seen in women, and comparable to frequent perineural involvement seen in other epithelial tumours such as pancreatic [54] and prostatic [55] adenocarcinoma where the organs have closer proximity to nerve bundles. While mixed prognostic significance of PNI has been seen in FBC studies [53], PNI positive tumours have been shown to be more often associated with positive nodal status and hormonal positivity [53], both of which are more commonly seen in MBC in general, and in our study cohort when compared with FBC.…”

The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer

“…In prostate cancer (PCa), the prevalence of PNI has been reported by many studies in patients with localized PCa. Yet, its incidence varies among different studies, with a proportion ranging from 23% to 90% in the radical prostatectomy (RP) specimen and 7% to 43% in the biopsy specimen (Harnden et al ., ; Merrilees et al ., ; Masieri et al ., ; Tollefson et al ., ). Although the exact clinical value of PNI remains controversial (Zareba et al ., ; Zhang et al ., ), the presence of PNI is still considered as one of the important mechanisms of PCa cells spreading beyond the prostate (Villers et al ., ).…”

Identification of Beta-2 as a Key Cell Adhesion Molecule in PCa Cell Neurotropic Behavior: A Novel Ex Vivo and Biophysical Approach

“…This phenomenon clinically is implicated to play a role in several cancers [15] including breast [16], head and neck [17], pancreatic [18], colon [19], penile [20] and prostate [21]–[26] amongst others. PNI is observed in over 80% of PCa core biopsy specimens [27] and is associated with multiple adverse pathological factors [19], [28]–[36] including stage, grade, and preoperative PSA. Most clinicians recognize PNI as the leading cause of prostatic egress and the mechanism through which PCa penetrates the prostatic capsule [37]; and, PCa cells have been observed in the endoneurium [38], [39] totally independent of lymphatic or vascular involvement [38].…”